Provider Demographics
NPI:1801998554
Name:GASKIN-SMITH, WANDA ROSE (PHD)
Entity type:Individual
Prefix:DR
First Name:WANDA
Middle Name:ROSE
Last Name:GASKIN-SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N CENTRAL EXPY
Mailing Address - Street 2:SUITE # 309
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-3519
Mailing Address - Country:US
Mailing Address - Phone:972-562-3800
Mailing Address - Fax:972-562-7860
Practice Address - Street 1:206 WESTPARK DR N
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-3530
Practice Address - Country:US
Practice Address - Phone:972-562-3800
Practice Address - Fax:972-562-7860
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10557101YP2500X
TX4528106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4228OtherLMFT
TX10557OtherLPC