Provider Demographics
NPI:1104832153
Name:SMITH, JO ANN (MED, LPC)
Entity Type:Individual
Prefix:MS
First Name:JO
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 AZURE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-2214
Mailing Address - Country:US
Mailing Address - Phone:479-422-3119
Mailing Address - Fax:479-452-5847
Practice Address - Street 1:3111 SOUTH 70TH STREET
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-1944
Practice Address - Country:US
Practice Address - Phone:479-444-5048
Practice Address - Fax:479-444-5039
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP9408023101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP9408023OtherLICENSED PROR. COUNSELOR