Provider Demographics
NPI:1922459742
Name:SMITH, MICHELLE R (LPC CLINICAL PSYCH)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC CLINICAL PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17045 EL CAMINO REAL STE 211
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2644
Mailing Address - Country:US
Mailing Address - Phone:713-304-9549
Mailing Address - Fax:
Practice Address - Street 1:17045 EL CAMINO REAL STE 211
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2644
Practice Address - Country:US
Practice Address - Phone:713-304-9549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72401101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health