Provider Demographics
NPI:1316037427
Name:SMITH, MARILYN LEWIS (LPC MHP)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:LEWIS
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 WINCHESTER AVENUE
Mailing Address - Street 2:SOUTHEAST MENTAL HEALTH CENTER
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-9007
Mailing Address - Country:US
Mailing Address - Phone:901-369-1420
Mailing Address - Fax:901-369-1433
Practice Address - Street 1:3810 WINCHESTER AVENUE
Practice Address - Street 2:SOUTHEAST MENTAL HEALTH CENTER
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-9007
Practice Address - Country:US
Practice Address - Phone:901-369-1420
Practice Address - Fax:901-369-1433
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000683101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional