Provider Demographics
NPI:1619362423
Name:SMITH, TONYA
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11901 TOEPPERWEIN RD STE 1106
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3159
Mailing Address - Country:US
Mailing Address - Phone:210-488-8997
Mailing Address - Fax:888-965-0531
Practice Address - Street 1:11901 TOEPPERWEIN RD STE 1106
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3159
Practice Address - Country:US
Practice Address - Phone:210-488-8997
Practice Address - Fax:888-965-0531
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70137101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional