Provider Demographics
NPI:1104145150
Name:SMITH, PARKE (MS, LPC, ASOTP)
Entity type:Individual
Prefix:
First Name:PARKE
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:MS, LPC, ASOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8820 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78239
Mailing Address - Country:US
Mailing Address - Phone:210-826-8686
Mailing Address - Fax:
Practice Address - Street 1:8820 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78239
Practice Address - Country:US
Practice Address - Phone:210-826-8686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64617101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional