Provider Demographics
NPI:1669844569
Name:SMITH, CHANTEL (LPC)
Entity type:Individual
Prefix:
First Name:CHANTEL
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 RESEARCH FOREST DR SUITE 180 BOX 406
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-6614
Mailing Address - Country:US
Mailing Address - Phone:936-463-8185
Mailing Address - Fax:346-703-0082
Practice Address - Street 1:33300 EGYPT LN STE I200
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-2741
Practice Address - Country:US
Practice Address - Phone:936-463-8185
Practice Address - Fax:346-703-0082
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-30
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67217101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional