Provider Demographics
NPI:1245597244
Name:SMITH, JUSTIN M (LMFT, LCADC)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:M
Last Name:SMITH
Suffix:
Gender:M
Credentials:LMFT, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 E RUSSELL RD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-2201
Mailing Address - Country:US
Mailing Address - Phone:702-530-8894
Mailing Address - Fax:
Practice Address - Street 1:3450 E RUSSELL RD
Practice Address - Street 2:SUITE 214
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-2201
Practice Address - Country:US
Practice Address - Phone:702-530-8894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2016-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01321106H00000X
NV00403-LC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)