Provider Demographics
NPI:1164609590
Name:SMITH, LUCIUS R (MS LMFT)
Entity Type:Individual
Prefix:MR
First Name:LUCIUS
Middle Name:R
Last Name:SMITH
Suffix:
Gender:M
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N WOODLAWN ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-4338
Mailing Address - Country:US
Mailing Address - Phone:316-393-2428
Mailing Address - Fax:316-260-7045
Practice Address - Street 1:400 N WOODLAWN ST
Practice Address - Street 2:SUITE 106
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4338
Practice Address - Country:US
Practice Address - Phone:316-393-2428
Practice Address - Fax:316-260-7045
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS914106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist