Provider Demographics
NPI:1720238694
Name:SMITH, LEE ANNE C (MA, LPC)
Entity Type:Individual
Prefix:
First Name:LEE ANNE
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 LONG PRAIRIE RD
Mailing Address - Street 2:SUITE 300-6
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-4839
Mailing Address - Country:US
Mailing Address - Phone:972-878-8784
Mailing Address - Fax:
Practice Address - Street 1:2604 LONG PRAIRIE RD
Practice Address - Street 2:SUITE 300-6
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-4839
Practice Address - Country:US
Practice Address - Phone:972-878-8784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71556101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX71556OtherTEXAS LPC
CO10195OtherCOLORADO LPC