Provider Demographics
NPI:1083931653
Name:SMITH, PATRICIA BAKER (LPC)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:BAKER
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1152 OLYMPIA AVE
Mailing Address - Street 2:UNIT G
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-2386
Mailing Address - Country:US
Mailing Address - Phone:303-776-8011
Mailing Address - Fax:
Practice Address - Street 1:1414 W 28TH ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-3101
Practice Address - Country:US
Practice Address - Phone:970-203-1300
Practice Address - Fax:970-203-0222
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-22
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002083101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health