Provider Demographics
NPI:1225099179
Name:SMITH, LAWRENCE M (LPC)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:M
Last Name:SMITH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4122 NE 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-6502
Mailing Address - Country:US
Mailing Address - Phone:503-331-1993
Mailing Address - Fax:
Practice Address - Street 1:5125 SW MACADAM AVE
Practice Address - Street 2:SUITE 145
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3820
Practice Address - Country:US
Practice Address - Phone:503-231-7854
Practice Address - Fax:503-231-8153
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1278101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional