Provider Demographics
NPI:1477763233
Name:SMITH, BETTY M (MC LMFT)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:MC LMFT
Other - Prefix:MRS
Other - First Name:BETTY
Other - Middle Name:KATHRYN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MCLMFT
Mailing Address - Street 1:1954 E BENDIX DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-4237
Mailing Address - Country:US
Mailing Address - Phone:480-831-8436
Mailing Address - Fax:480-831-8436
Practice Address - Street 1:1954 E BENDIX DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-4237
Practice Address - Country:US
Practice Address - Phone:480-831-8436
Practice Address - Fax:480-831-8436
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT10095106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ829020OtherAHCCCS PROVIDER#