Provider Demographics
NPI:1134458904
Name:SMITH, SADIE R (MA, LMFT, LCPC)
Entity Type:Individual
Prefix:MS
First Name:SADIE
Middle Name:R
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, LMFT, LCPC
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 6506
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59771-6506
Mailing Address - Country:US
Mailing Address - Phone:406-600-0348
Mailing Address - Fax:406-600-0348
Practice Address - Street 1:202 S BLACK AVE
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6246
Practice Address - Country:US
Practice Address - Phone:406-600-0348
Practice Address - Fax:406-600-0348
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLMFT-160106H00000X
CO1048106H00000X
MT8215101YP2500X
MT8031106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional