Provider Demographics
NPI:1073360897
Name:SMITH, ROCHELLE D (COUNSELOR)
Entity type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:MS
Other - First Name:ROCHELLE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1324 VENTURA CREEK DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-5189
Mailing Address - Country:US
Mailing Address - Phone:346-300-8735
Mailing Address - Fax:
Practice Address - Street 1:1324 VENTURA CREEK DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-5189
Practice Address - Country:US
Practice Address - Phone:346-300-8735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YP2500X
TX17967101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional