Provider Demographics
NPI:1124464797
Name:SMITH, GINGER L (LPC)
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:L
Last Name:SMITH
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 1:4133 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:LONE STAR
Mailing Address - State:TX
Mailing Address - Zip Code:75668-2523
Mailing Address - Country:US
Mailing Address - Phone:903-767-2607
Mailing Address - Fax:
Practice Address - Street 1:650 CR 4650
Practice Address - Street 2:
Practice Address - City:MT. PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455
Practice Address - Country:US
Practice Address - Phone:903-767-2607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68190101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional