Provider Demographics
NPI:1124398292
Name:SMITH, LYNN ARTHUR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:LYNN
Middle Name:ARTHUR
Last Name:SMITH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1166
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84528-1166
Mailing Address - Country:US
Mailing Address - Phone:801-910-7286
Mailing Address - Fax:801-998-3635
Practice Address - Street 1:130 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:UT
Practice Address - Zip Code:84528-1166
Practice Address - Country:US
Practice Address - Phone:801-910-7286
Practice Address - Fax:801-998-3635
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6008469-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical