Provider Demographics
NPI:1508262569
Name:CAROL LEE SMITH PSYCHOTHERAPY
Entity Type:Organization
Organization Name:CAROL LEE SMITH PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:SOCIAL WORKER
Authorized Official - Phone:425-202-5199
Mailing Address - Street 1:11700 MUKILTEO SPEEDWAY
Mailing Address - Street 2:STE. 201-1043
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-5432
Mailing Address - Country:US
Mailing Address - Phone:425-202-5199
Mailing Address - Fax:425-315-8835
Practice Address - Street 1:9 LAKE BELLEVUE DR
Practice Address - Street 2:STE. 214
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2454
Practice Address - Country:US
Practice Address - Phone:425-202-5199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00005650101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty