Provider Demographics
NPI:1093951089
Name:SMITH, JOHN EDWARD (LMHC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:SMITH
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 UNION ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-1363
Mailing Address - Country:US
Mailing Address - Phone:727-298-3905
Mailing Address - Fax:727-298-3905
Practice Address - Street 1:1615 UNION ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-1363
Practice Address - Country:US
Practice Address - Phone:727-298-3905
Practice Address - Fax:727-298-3905
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5254101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health