Provider Demographics
NPI:1285952317
Name:SMITH, RACHEL ANNA (MA, LPC, LCDC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANNA
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3223 S LOOP 289 STE 145
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1336
Mailing Address - Country:US
Mailing Address - Phone:806-370-0327
Mailing Address - Fax:
Practice Address - Street 1:1628 19TH STREET
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401-4832
Practice Address - Country:US
Practice Address - Phone:806-219-0500
Practice Address - Fax:806-766-1286
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11106101YA0400X
TX68624101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3172017-03Medicaid
TX68624OtherTEXAS BEHAVIORAL HEALTH EXECUTIVE COUNSEL
TX11106OtherTEXAS DEPARTMENT OF STATE HEALTH SERVICES
TX3172017-01Medicaid