Provider Demographics
NPI:1073911913
Name:SMITH, MARCUS (LPCC)
Entity Type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-9325
Mailing Address - Country:US
Mailing Address - Phone:575-749-2792
Mailing Address - Fax:888-276-3843
Practice Address - Street 1:3017 N PRINCE ST STE B
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-3804
Practice Address - Country:US
Practice Address - Phone:575-749-2792
Practice Address - Fax:888-276-3843
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0163181101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional