Smart, Wanda Ellen
Smart, Wanda Ellen is an sole proprietor health care provider with primary practice located at 501 Pine Tree Rd Ste A-0 , Longview TX 75604-4000. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Professional is her primary health care specialty. Smart, Wanda Ellen can be contacted via phone (903) 758-2610.Contact Information
Primary practice address
501 Pine Tree Rd Ste A-0
Longview TX 75604-4000
Phone: (903) 758-2610
Fax: (903) 758-3124
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | 13802 | Texas |
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | ||
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | 13802 | Texas |
Profile Details
| NPI number | 1912058629 |
|---|---|
| LBN Legal business name | Smart, Wanda Ellen |
| Credentials | Licensed Professional Counselor (LPC) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 16th, 2007 |
| Last updated | Jan 5th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1912058629 | NPPES |
| Texas | Other | 13802 | LICENSE TO PRACTICE |
| Texas | MEDICAID | 1130684-01 | LICENSE TO PRACTICE |
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