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Provider Information for 1093215261


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ERCELIA ESTELA SMITH LPS, LCDC


Sex: Female

NPI: 1093215261
Last Updated: 2024-02-08
Certification Date: 2024-02-08

Details

NameValue
NPI1093215261
Enumeration Date2018-02-14
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 4 STADIUM DR APT 1003
ANGLETON, TX 77515-2548
United States

Phone: 979-319-0713 | Fax:
 
Primary Practice Address 4 STADIUM DR
ANGLETON, TX 77515-2543
United States

Phone: 979-319-0713 | Fax:
 
Secondary Practice Address(es)

9401 SOUTHWEST FWY
HOUSTON, TX 77074-1407
United States

Phone: 713-970-7000 | Fax:
 

Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other URL
NA
4 Stadium Dr
Angleton, TX 77515-2543
United States
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 101YA0400X - Counselor - Addiction (Substance Use Disorder)TX14114
Yes 101YP2500X - Counselor - ProfessionalTX79111