Provider Demographics
NPI:1811503543
Name:SMITH, JACQUELINE MAREE (MA, LCDC, LPC, LMFTA)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:MAREE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, LCDC, LPC, LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 MCKINNEY ST # 583
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-6308
Mailing Address - Country:US
Mailing Address - Phone:832-304-4755
Mailing Address - Fax:
Practice Address - Street 1:8877 FRANKWAY DR APT 4442
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-1909
Practice Address - Country:US
Practice Address - Phone:832-978-3567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14126101YA0400X
TX203944106H00000X
TX83256101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist