Provider Demographics
NPI:1487966776
Name:SMITH, AMY RENEE (LPC, LCMHCS, CCS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:RENEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC, LCMHCS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 CASA RIO CIR # A7
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-6725
Mailing Address - Country:US
Mailing Address - Phone:832-658-9733
Mailing Address - Fax:
Practice Address - Street 1:10000 EMMETT F LOWRY EXPY STE 1220
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-2129
Practice Address - Country:US
Practice Address - Phone:409-763-2373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1954101YA0400X
101YP2500X
TX83267101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104529Medicaid