Provider Demographics
NPI:1457425191
Name:SMITH, CATHERINE ANN (MED, LPC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4402 LAKE SHORE DR APT D
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-1949
Mailing Address - Country:US
Mailing Address - Phone:254-733-5300
Mailing Address - Fax:254-399-8325
Practice Address - Street 1:801 WASHINGTON AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76701-1282
Practice Address - Country:US
Practice Address - Phone:254-733-5300
Practice Address - Fax:254-399-8325
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18183101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional