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
Certification Date: 2024-02-08
Details
Name | Value | ||||||||||||||
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NPI | 1093215261 | ||||||||||||||
Enumeration Date | 2018-02-14 | ||||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||||
Sole Proprietor | YES | ||||||||||||||
Status | Active | ||||||||||||||
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 | ||||||||||||||
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