Provider Demographics
NPI:1174663934
Name:SMITH, LISA KAYE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:KAYE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 VETERANS PKWY
Mailing Address - Street 2:APT 606
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-6441
Mailing Address - Country:US
Mailing Address - Phone:615-926-4790
Mailing Address - Fax:
Practice Address - Street 1:2320 SOUTHGATE BLVD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-5532
Practice Address - Country:US
Practice Address - Phone:615-895-1961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical