Provider Demographics
NPI:1407036114
Name:SMITH, GINA LANEECE (LCP, LMLP)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:LANEECE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCP, LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 GENERAL HAYS RD STE B
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2256
Mailing Address - Country:US
Mailing Address - Phone:785-628-0550
Mailing Address - Fax:
Practice Address - Street 1:2604 GENERAL HAYS RD STE B
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2256
Practice Address - Country:US
Practice Address - Phone:785-628-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCP 043, LMLP 0371103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical