Provider Demographics
NPI:1508240664
Name:SMITH, LAUREN SAMANTHA (LSCSW, RPT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:SAMANTHA
Last Name:SMITH
Suffix:
Gender:F
Credentials:LSCSW, RPT
Other - Prefix:
Other - First Name:L.
Other - Middle Name:SAMANTHA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSCSW, RPT
Mailing Address - Street 1:1421 E 2ND ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-4119
Mailing Address - Country:US
Mailing Address - Phone:316-640-2584
Mailing Address - Fax:
Practice Address - Street 1:1421 E 2ND ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4119
Practice Address - Country:US
Practice Address - Phone:316-685-9311
Practice Address - Fax:316-633-4283
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS49181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201132160BMedicaid