Individual
MRS. STEPHANIE JILL SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC-S, LCDC
Contact information
Practice address
4405 PADRE BLVD, SOUTH PADRE ISLAND, TX 78597-7324
(956) 367-5687
Mailing address
PO BOX 40167, SOUTH PADRE ISLAND, TX 78597-4167
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
67438
TX
101YA0400X
Addiction (Substance Use Disorder) Counselor
11287
TX
101YM0800X
Mental Health Counselor
67438
TX
101YP2500X
Professional Counselor
67438
TX
Other
Enumeration date
02/09/2018
Last updated
02/09/2018
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