Provider Demographics
NPI:1619083334
Name:SMITHSON, BILLIE L (MA LPC)
Entity Type:Individual
Prefix:MS
First Name:BILLIE
Middle Name:L
Last Name:SMITHSON
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:BILLIE
Other - Middle Name:L
Other - Last Name:VINES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4901 BROADWAY
Mailing Address - Street 2:STE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5734
Mailing Address - Country:US
Mailing Address - Phone:210-822-5795
Mailing Address - Fax:210-822-5939
Practice Address - Street 1:4901 BROADWAY
Practice Address - Street 2:STE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5734
Practice Address - Country:US
Practice Address - Phone:210-822-5795
Practice Address - Fax:210-822-5939
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10336101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1492LCOtherBCBS