Provider Demographics
NPI:1821424813
Name:SMITH, JULIANNE (LPC)
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 E RENFRO ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-3938
Mailing Address - Country:US
Mailing Address - Phone:817-372-2697
Mailing Address - Fax:
Practice Address - Street 1:240 E RENFRO ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-3938
Practice Address - Country:US
Practice Address - Phone:817-372-2697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68775101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional