Provider Demographics
NPI:1558852103
Name:MEJIA-SMITH, TATIANA FELICIA (LCSW)
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:FELICIA
Last Name:MEJIA-SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TATIANA
Other - Middle Name:FELICIA
Other - Last Name:MEJIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:6100 VERANDAS CIR APT 822
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4165
Mailing Address - Country:US
Mailing Address - Phone:817-229-5627
Mailing Address - Fax:
Practice Address - Street 1:4019 WOODLAND PARK BLVD STE 113
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-4468
Practice Address - Country:US
Practice Address - Phone:682-206-8691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX584921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical