Provider Demographics
NPI:1447999255
Name:SMART, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SMART
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 1:150 WILHEM WAY
Mailing Address - Street 2:
Mailing Address - City:UHLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78640-2498
Mailing Address - Country:US
Mailing Address - Phone:210-860-0440
Mailing Address - Fax:
Practice Address - Street 1:8500 N MOPAC EXPY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8375
Practice Address - Country:US
Practice Address - Phone:512-902-3282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool