Provider Demographics
NPI:1881007763
Name:SMITH, BRANDY MICHELLE (MED, LPC)
Entity Type:Individual
Prefix:MISS
First Name:BRANDY
Middle Name:MICHELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 HIGHGATE DR
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-4110
Mailing Address - Country:US
Mailing Address - Phone:214-714-5060
Mailing Address - Fax:
Practice Address - Street 1:1711 HIGHGATE DR
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-4110
Practice Address - Country:US
Practice Address - Phone:214-714-5060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68201101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional