Provider Information for 1245677566
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RYAN M SMITH LPC
Sex: Male
NPI: 1245677566
Last Updated: 2013-05-28
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1245677566 | ||||||||
| Enumeration Date | 2013-05-28 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 99213 FORT WORTH, TX 76199-0213 United States Phone: 682-885-1892 | Fax:682-885-3936 | ||||||||
| Primary Practice Address | 801 7TH AVE FORT WORTH, TX 76104-2733 United States Phone: 682-885-3878 | Fax:682-885-1672 | ||||||||
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