Provider Demographics
NPI:1093046708
Name:SMETAK, JODY (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:SMETAK
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 LEE ST SE
Mailing Address - Street 2:STE C
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-6721
Mailing Address - Country:US
Mailing Address - Phone:360-970-1393
Mailing Address - Fax:360-753-8981
Practice Address - Street 1:116 LEE ST SE
Practice Address - Street 2:STE C
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-6721
Practice Address - Country:US
Practice Address - Phone:360-970-1393
Practice Address - Fax:360-753-8981
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health