Provider Demographics
NPI:1568695500
Name:SMITH, PETER (MED, LCDC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:MED, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 577
Mailing Address - Street 2:
Mailing Address - City:LOCKHART
Mailing Address - State:TX
Mailing Address - Zip Code:78644-0577
Mailing Address - Country:US
Mailing Address - Phone:512-376-2101
Mailing Address - Fax:512-398-5696
Practice Address - Street 1:896 ROBIN RANCH RD
Practice Address - Street 2:
Practice Address - City:LOCKHART
Practice Address - State:TX
Practice Address - Zip Code:78644-4578
Practice Address - Country:US
Practice Address - Phone:512-376-2101
Practice Address - Fax:512-398-5696
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9265101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX9265OtherTDSHS CHEMICAL DEPENDENCY COUNELSOR