Provider Demographics
NPI:1225596786
Name:SMITH, MELEAH BETH LISTER (LMHC)
Entity Type:Individual
Prefix:
First Name:MELEAH
Middle Name:BETH LISTER
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MELEAH
Other - Middle Name:BETH
Other - Last Name:LISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:233 LUCY DR
Mailing Address - Street 2:
Mailing Address - City:WEWAHITCHKA
Mailing Address - State:FL
Mailing Address - Zip Code:32465-4629
Mailing Address - Country:US
Mailing Address - Phone:850-628-6027
Mailing Address - Fax:
Practice Address - Street 1:625 JENKS AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2629
Practice Address - Country:US
Practice Address - Phone:850-215-5657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health