Provider Demographics
NPI:1659767101
Name:SMITH, CHRISTINA G (BS, MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:G
Last Name:SMITH
Suffix:
Gender:F
Credentials:BS, MA, LPC
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:G
Other - Last Name:SANNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6105 DENTON HWY STE 80
Mailing Address - Street 2:
Mailing Address - City:HALTOM CITY
Mailing Address - State:TX
Mailing Address - Zip Code:76148-3021
Mailing Address - Country:US
Mailing Address - Phone:817-654-5790
Mailing Address - Fax:817-221-0588
Practice Address - Street 1:6105 DENTON HWY STE 80
Practice Address - Street 2:
Practice Address - City:HALTOM CITY
Practice Address - State:TX
Practice Address - Zip Code:76148-3021
Practice Address - Country:US
Practice Address - Phone:817-654-5790
Practice Address - Fax:817-221-0588
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-11
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63048101Y00000X, 101YA0400X, 101YM0800X, 101YP1600X, 103K00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX348177202Medicaid
TX348177201Medicaid