Provider Demographics
NPI:1811244155
Name:SMITH, SCOTT ALLEN (MA, LPC, CH)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALLEN
Last Name:SMITH
Suffix:
Gender:M
Credentials:MA, LPC, CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 KATINA DR
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-7580
Mailing Address - Country:US
Mailing Address - Phone:309-363-2544
Mailing Address - Fax:
Practice Address - Street 1:2508 KATINA DR
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-7580
Practice Address - Country:US
Practice Address - Phone:682-204-1825
Practice Address - Fax:682-307-5272
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69365101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional