Provider Demographics
NPI:1295381994
Name:SMITH, JENNIFER KATE (LCSW, LAC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KATE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8011
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59807-8011
Mailing Address - Country:US
Mailing Address - Phone:406-370-5162
Mailing Address - Fax:
Practice Address - Street 1:300 W BROADWAY ST STE 2
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4126
Practice Address - Country:US
Practice Address - Phone:406-370-5162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-18
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT38104101YA0400X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)