Provider Demographics
NPI:1831639566
Name:SMITH, ERIC D (LPC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:D
Last Name:SMITH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 OLLERTON DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77303-1813
Mailing Address - Country:US
Mailing Address - Phone:713-878-8500
Mailing Address - Fax:936-549-2100
Practice Address - Street 1:3 OLLERTON DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77303-1813
Practice Address - Country:US
Practice Address - Phone:713-878-8500
Practice Address - Fax:936-549-2100
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74080101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX74080OtherTEXAS LPC BOARD