Active NPI
Charles Marcus Smith, LPC
- Professional Counselor
- Willis, TX
National Provider Identifier
1831436211
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 64645
- Practice address
- 11861 Nelwood St
Willis, TX 77318-7278 - Phone
- (936) 333-6230
- NPI assigned
- Jan 6, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 10920 | TX | |
| Professional Counselor | 101YP2500X | 64645 | TX | Primary |
Addresses
Primary practice location
11861 Nelwood St
Willis, TX 77318-7278
Mailing address
11861 Nelwood St
Willis, TX 77318-7278
Phone (936) 333-6230
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 64645 | TX | MD | Professional Counselor |
| 10920 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1357430400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1357430400000",
"number": "1831436211",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11861 NELWOOD ST",
"city": "WILLIS",
"state": "TX",
"postal_code": "773187278",
"telephone_number": "936-333-6230"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11861 NELWOOD ST",
"city": "WILLIS",
"state": "TX",
"postal_code": "773187278",
"telephone_number": "936-333-6230"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "CHARLES",
"middle_name": "MARCUS",
"name_prefix": "Mr.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-01-06",
"last_updated": "2013-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "TX",
"license": "10920",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "64645",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Willis, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.