Provider Demographics
NPI:1013786078
Name:SMITH, MICHAEL HASTINGS (LMFT - ASSOCIATE)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:HASTINGS
Last Name:SMITH
Suffix:
Gender:M
Credentials:LMFT - ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21015 MARKET RDG STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4975
Mailing Address - Country:US
Mailing Address - Phone:210-496-0100
Mailing Address - Fax:
Practice Address - Street 1:21015 MARKET RDG STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4975
Practice Address - Country:US
Practice Address - Phone:210-496-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205153106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist