Provider Demographics
NPI:1508040882
Name:SMITH, PAIGE (MS)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3629 SKYLINE BLVD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5681
Mailing Address - Country:US
Mailing Address - Phone:775-273-8864
Mailing Address - Fax:
Practice Address - Street 1:180 W HUFFAKER LN STE 303
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2091
Practice Address - Country:US
Practice Address - Phone:775-273-8864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-22
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41441106H00000X
NV01329106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist