Provider Demographics
NPI:1578801916
Name:SMITH, RYAN RANDALL (PHD, LMFT-S, LPC-S)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:RANDALL
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD, LMFT-S, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 OLD MILLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-8368
Mailing Address - Country:US
Mailing Address - Phone:972-653-2919
Mailing Address - Fax:
Practice Address - Street 1:844 OLD MILLWOOD RD
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-8368
Practice Address - Country:US
Practice Address - Phone:972-653-2919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69270101YP2500X
TX201943106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional