Provider Demographics
NPI:1073888392
Name:SMOTHERMAN, REBECCA JO (MS, LPC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JO
Last Name:SMOTHERMAN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 758
Mailing Address - Street 2:
Mailing Address - City:CABOOL
Mailing Address - State:MO
Mailing Address - Zip Code:65689-0758
Mailing Address - Country:US
Mailing Address - Phone:417-254-1119
Mailing Address - Fax:
Practice Address - Street 1:13475 INDUSTRIAL DRIVE
Practice Address - Street 2:
Practice Address - City:CABOOL
Practice Address - State:MO
Practice Address - Zip Code:65689
Practice Address - Country:US
Practice Address - Phone:417-254-1119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO201100811101Y00000X
MO2011008110101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor