Provider Demographics
NPI:1013409994
Name:SMITH, REESA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:REESA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9249 W SWIMMING HOLE LN
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:IN
Mailing Address - Zip Code:46064-8659
Mailing Address - Country:US
Mailing Address - Phone:765-610-9864
Mailing Address - Fax:
Practice Address - Street 1:412 S. MAPLE ST.
Practice Address - Street 2:SUITE 100B
Practice Address - City:FORTVILLE
Practice Address - State:IN
Practice Address - Zip Code:46040
Practice Address - Country:US
Practice Address - Phone:765-276-7131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35002048A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist