Provider Demographics
NPI:1457123929
Name:SMITH, MADELINE LORIN (LMFT-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:LORIN
Last Name:SMITH
Suffix:
Gender:F
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 1:13341 W HIGHWAY 290 UNIT 103
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-9160
Mailing Address - Country:US
Mailing Address - Phone:512-829-4210
Mailing Address - Fax:
Practice Address - Street 1:13341 W HIGHWAY 290 UNIT 103
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737-9160
Practice Address - Country:US
Practice Address - Phone:512-829-4210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205223106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist