Provider Demographics
NPI:1275875452
Name:SMITH, JOANNA (MA LMFT)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 SLATER RD STE 210
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55122-4055
Mailing Address - Country:US
Mailing Address - Phone:651-882-6299
Mailing Address - Fax:
Practice Address - Street 1:4660 SLATER RD STE 210
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55122-4055
Practice Address - Country:US
Practice Address - Phone:651-882-6299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist