Provider Demographics
NPI:1053421545
Name:SMITH, GLORIA P (MA, LPC, LMFT)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:P
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1176 COUNTY ROAD 2699
Mailing Address - Street 2:
Mailing Address - City:LOMETA
Mailing Address - State:TX
Mailing Address - Zip Code:76853-3912
Mailing Address - Country:US
Mailing Address - Phone:512-752-3106
Mailing Address - Fax:512-752-4428
Practice Address - Street 1:15303 HUEBNER ROAD
Practice Address - Street 2:SUITE 10
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-0982
Practice Address - Country:US
Practice Address - Phone:210-497-2880
Practice Address - Fax:210-526-0387
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2354106H00000X
TX7430101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist