Provider Demographics
NPI:1548088651
Name:SMARTT, WENDY HENRICHSON
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:HENRICHSON
Last Name:SMARTT
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 1:10127 MOROCCO ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-3938
Mailing Address - Country:US
Mailing Address - Phone:210-838-5351
Mailing Address - Fax:
Practice Address - Street 1:10127 MOROCCO ST STE 202
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-3938
Practice Address - Country:US
Practice Address - Phone:210-326-7191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31690103TS0200X
TX30540103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool