Provider Demographics
NPI:1861813453
Name:SMITH, JIMMY (LPC)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:
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 1:1506 N GREENVILLE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-8622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1506 N GREENVILLE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-8622
Practice Address - Country:US
Practice Address - Phone:214-509-6888
Practice Address - Fax:214-509-6887
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-26
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68085101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor