Provider Demographics
NPI:1508352535
Name:SMITH, MISTY B (MA, LPC-MHSP, NCC)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:B
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, LPC-MHSP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6050 AIRLINE RD STE 108
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-4894
Mailing Address - Country:US
Mailing Address - Phone:901-422-4002
Mailing Address - Fax:
Practice Address - Street 1:6050 AIRLINE RD STE 108
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-4894
Practice Address - Country:US
Practice Address - Phone:901-422-4002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4311101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional