Provider Demographics
NPI:1770881757
Name:TAYLOR-SMITH, DEBRA RENEA (MS)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:RENEA
Last Name:TAYLOR-SMITH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 GRAPEVINE HWY
Mailing Address - Street 2:SUITE 340
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-2782
Mailing Address - Country:US
Mailing Address - Phone:817-307-6446
Mailing Address - Fax:
Practice Address - Street 1:500 GRAPEVINE HWY
Practice Address - Street 2:SUITE 340
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2782
Practice Address - Country:US
Practice Address - Phone:817-307-6446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201379106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist