Provider Demographics
NPI:1851171037
Name:SMITH, JASON MICHAEL (LMFT-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:MICHAEL
Last Name:SMITH
Suffix:
Gender:M
Credentials:LMFT-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 RED RIVER TRL APT 1102
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-6384
Mailing Address - Country:US
Mailing Address - Phone:817-360-6594
Mailing Address - Fax:
Practice Address - Street 1:3700 RIVER WALK DR STE 275
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1860
Practice Address - Country:US
Practice Address - Phone:972-841-1731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204963106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist