Provider Demographics
NPI:1326870445
Name:SMITH, ADRIENNE JANETTE
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:JANETTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14940 COUNTY ROAD 4015
Mailing Address - Street 2:
Mailing Address - City:MABANK
Mailing Address - State:TX
Mailing Address - Zip Code:75147-3453
Mailing Address - Country:US
Mailing Address - Phone:972-824-7983
Mailing Address - Fax:
Practice Address - Street 1:14940 COUNTY ROAD 4015
Practice Address - Street 2:
Practice Address - City:MABANK
Practice Address - State:TX
Practice Address - Zip Code:75147-3453
Practice Address - Country:US
Practice Address - Phone:972-824-7983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72439103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool