Provider Demographics
NPI:1114997079
Name:SMITH, DAVID ALAN (LPC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:A
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1465 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUSH VALLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84069-9749
Mailing Address - Country:US
Mailing Address - Phone:435-837-2223
Mailing Address - Fax:
Practice Address - Street 1:100 S 1000 W
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-4010
Practice Address - Country:US
Practice Address - Phone:435-843-3520
Practice Address - Fax:435-843-3555
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1296206004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107001587101OtherINTRMTN. HEALTH CARE
UT297800OtherDESERET MUTUAL
UT942938348SH1OtherEDUCATORS MUTUAL
UTNPP000Medicare UPIN