Provider Demographics
NPI:1659006799
Name:SMITH, MONIQUE JALAYNE
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:JALAYNE
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 1:802 CAVEHILL CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-4472
Mailing Address - Country:US
Mailing Address - Phone:281-406-4708
Mailing Address - Fax:
Practice Address - Street 1:802 CAVEHILL CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-4472
Practice Address - Country:US
Practice Address - Phone:281-406-4708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health