Provider Demographics
NPI:1811720477
Name:SMITH, LIDIA (MS, NCC)
Entity type:Individual
Prefix:
First Name:LIDIA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, NCC
Other - Prefix:
Other - First Name:LIDIA
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 ROCKBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-4806
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:109 W VIRGINIA ST STE 203A
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-4421
Practice Address - Country:US
Practice Address - Phone:480-216-6752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health