Provider Demographics
NPI:1528248804
Name:SMITH, MICHAEL ANDREW (LCSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANDREW
Last Name:SMITH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 WILKES ST
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78957-1642
Mailing Address - Country:US
Mailing Address - Phone:512-565-1707
Mailing Address - Fax:
Practice Address - Street 1:503 WILKES ST
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TX
Practice Address - Zip Code:78957-1642
Practice Address - Country:US
Practice Address - Phone:512-565-1707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX326251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical