Provider Demographics
NPI:1881021921
Name:SMITH, MEGAN DEANN
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:DEANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 COUNTY ROAD 420
Mailing Address - Street 2:
Mailing Address - City:SPICEWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78669-3077
Mailing Address - Country:US
Mailing Address - Phone:830-798-2220
Mailing Address - Fax:
Practice Address - Street 1:840 COUNTY ROAD 420
Practice Address - Street 2:
Practice Address - City:SPICEWOOD
Practice Address - State:TX
Practice Address - Zip Code:78669-3077
Practice Address - Country:US
Practice Address - Phone:830-798-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12481101YA0400X
TX54286104100000X
MD16890104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)