Provider Demographics
NPI:1356389548
Name:SMITH, ROSAURA L (MS,LPC,)
Entity type:Individual
Prefix:
First Name:ROSAURA
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS,LPC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8489
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78468-8489
Mailing Address - Country:US
Mailing Address - Phone:361-993-3491
Mailing Address - Fax:361-993-6670
Practice Address - Street 1:4501 UP RIVER RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78408-3008
Practice Address - Country:US
Practice Address - Phone:361-993-3491
Practice Address - Fax:361-993-6670
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15141101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX027889-701Medicaid