Provider Demographics
NPI:1942351713
Name:SMITH, DEBRA KAY (PHD)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:KAY
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:DEBRA
Other - Middle Name:KAY
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:204 BLUFFVIEW LN
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75109-9565
Mailing Address - Country:US
Mailing Address - Phone:903-641-5644
Mailing Address - Fax:
Practice Address - Street 1:204 BLUFFVIEW LN
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75109-9565
Practice Address - Country:US
Practice Address - Phone:903-641-5644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4651101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX026064802Medicaid