Provider Demographics
NPI:1376553784
Name:SMITH, CLARA ELLEN (LCSW)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:ELLEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 PINECREST ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37683-1739
Mailing Address - Country:US
Mailing Address - Phone:423-727-7684
Mailing Address - Fax:
Practice Address - Street 1:11701 BELCHER RD S
Practice Address - Street 2:SUITE 111
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-5135
Practice Address - Country:US
Practice Address - Phone:800-632-6074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000001039101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health