Provider Demographics
NPI:1447453543
Name:LYNELL SMITH
Entity type:Organization
Organization Name:LYNELL SMITH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-638-0224
Mailing Address - Street 1:9203 HIGHWAY 6 S
Mailing Address - Street 2:SUITE 124 BOX 269
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-6386
Mailing Address - Country:US
Mailing Address - Phone:281-638-0224
Mailing Address - Fax:
Practice Address - Street 1:9203 HIGHWAY 6 S STE 124-269
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-6386
Practice Address - Country:US
Practice Address - Phone:281-638-0224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX001008051251B00000X
TX001008050251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001008050OtherCONTRACT NUMBER
TX001008051OtherCONTRACT NUMBER