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:
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Health care specialties

SpecialtyCodeLicense #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 5 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912058629 NPPES
Texas Other 13802 LICENSE TO PRACTICE
Texas MEDICAID 1130684-01 LICENSE TO PRACTICE

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