Provider Demographics
NPI:1073925012
Name:SMITH, SAMUEL MARQUE (PSYD, LMHC)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:MARQUE
Last Name:SMITH
Suffix:
Gender:M
Credentials:PSYD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 NW 85TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-3120
Mailing Address - Country:US
Mailing Address - Phone:206-659-5945
Mailing Address - Fax:206-494-4562
Practice Address - Street 1:5000 ABBEY WAY SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-3200
Practice Address - Country:US
Practice Address - Phone:360-412-6123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-26
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61089792101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health