Provider Demographics
NPI:1235484999
Name:SMITH, RICK E (LPC)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:E
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 1:4200 LITTLE BLUE PKWY
Mailing Address - Street 2:SUITE 360
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-8312
Mailing Address - Country:US
Mailing Address - Phone:816-373-9240
Mailing Address - Fax:
Practice Address - Street 1:4200 LITTLE BLUE PKWY
Practice Address - Street 2:SUITE 360
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-8312
Practice Address - Country:US
Practice Address - Phone:816-373-9240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010040544101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health