Provider Demographics
NPI:1447727680
Name:FORD SMITH, KAYTLYN MARIE
Entity type:Individual
Prefix:
First Name:KAYTLYN
Middle Name:MARIE
Last Name:FORD SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7555 DERBY VIS
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:TX
Mailing Address - Zip Code:78154-3943
Mailing Address - Country:US
Mailing Address - Phone:832-768-5187
Mailing Address - Fax:
Practice Address - Street 1:1919 NW LOOP 410 STE 201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2307
Practice Address - Country:US
Practice Address - Phone:832-768-5187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77661101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional