Provider Demographics
NPI:1063920551
Name:SMART, SUSAN R (LPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:SMART
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10807 PERN BETL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-3144
Mailing Address - Country:US
Mailing Address - Phone:210-245-7862
Mailing Address - Fax:210-245-7951
Practice Address - Street 1:10807 PERN BETL RD STE 300
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-3144
Practice Address - Country:US
Practice Address - Phone:210-245-7862
Practice Address - Fax:210-245-7951
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional