Provider Demographics
NPI:1073678876
Name:SMITH, LINDA GEORGETTE (LCSW, LPC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:GEORGETTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 SHELBY ST
Mailing Address - Street 2:
Mailing Address - City:HIGGINSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64037-2079
Mailing Address - Country:US
Mailing Address - Phone:660-584-3043
Mailing Address - Fax:660-584-7846
Practice Address - Street 1:123 E GAY ST
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-1809
Practice Address - Country:US
Practice Address - Phone:660-747-9242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000272101Y00000X, 101YM0800X, 101YP2500X
MO0041731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2004505OtherCIGNA PROVIDER #
MO210121OtherMHN PROVIDER #
MO24930021OtherBC PROVIDER #
MO24930021OtherBC PROVIDER #