Provider Demographics
NPI:1124015060
Name:SMITH, DENNIS DALE (LCPC)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:DALE
Last Name:SMITH
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16132 S COLE ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-3174
Mailing Address - Country:US
Mailing Address - Phone:913-530-4736
Mailing Address - Fax:913-782-9788
Practice Address - Street 1:815 S CLAIRBORNE RD
Practice Address - Street 2:SUITE 275 A
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1717
Practice Address - Country:US
Practice Address - Phone:913-530-4736
Practice Address - Fax:913-782-9788
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS023101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional