Active NPI
Wanda Ellen Smart, L.P.C.
- Professional Counselor
- Longview, TX
National Provider Identifier
1912058629
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 13802
- Practice address
- 501 Pine Tree Rd Ste a-0
Longview, TX 75604-4000 - Phone
- (903) 758-2610
- Fax
- (903) 758-3124
- NPI assigned
- Jan 16, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 13802 | TX | |
| Professional Counselor | 101YP2500X | |||
| Professional Counselor | 101YP2500X | 13802 | TX | Primary |
Addresses
Primary practice location
501 Pine Tree Rd Ste a-0
Longview, TX 75604-4000
Mailing address
PO Box 6402
Longview, TX 75608-6402
Phone (903) 758-2610
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 13802 | Other | TX | LICENSE TO PRACTICE |
| 1130684-01 | Medicaid | TX |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | 8668421649 | Direct |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609804800000",
"number": "1912058629",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 6402",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756086402",
"telephone_number": "903-758-2610",
"fax_number": "903-758-3124"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 PINE TREE RD STE A-0",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756044000",
"telephone_number": "903-758-2610",
"fax_number": "903-758-3124"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMART",
"first_name": "WANDA",
"middle_name": "ELLEN",
"name_prefix": "Ms.",
"credential": "L.P.C.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-16",
"last_updated": "2021-01-05",
"certification_date": "2021-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "13802",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "13802",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE TO PRACTICE",
"identifier": "13802",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1130684-01",
"state": "TX"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "8668421649",
"affiliation": "N",
"endpointDescription": "FAX",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "501 Pine Tree Rd Ste A-0",
"city": "Longview",
"state": "TX",
"country_code": "US",
"postal_code": "756044000",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Longview, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.