Provider Demographics
NPI:1104018985
Name:SAMUEL M. SMITH, MA, LMFT, LMHC
Entity Type:Organization
Organization Name:SAMUEL M. SMITH, MA, LMFT, LMHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE & FAMILY THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT, LMHC
Authorized Official - Phone:317-466-9809
Mailing Address - Street 1:4920 COMMON VISTA CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-5394
Mailing Address - Country:US
Mailing Address - Phone:317-466-9809
Mailing Address - Fax:317-466-9809
Practice Address - Street 1:4920 COMMON VISTA CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-5394
Practice Address - Country:US
Practice Address - Phone:317-466-9809
Practice Address - Fax:317-466-9809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001463A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty