Provider Demographics
NPI:1508922345
Name:SMITH, SUSAN GREY (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:GREY
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 DARBY CREEK RD
Mailing Address - Street 2:SUITE 67
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1604
Mailing Address - Country:US
Mailing Address - Phone:859-263-4687
Mailing Address - Fax:859-264-1760
Practice Address - Street 1:501 DARBY CREEK RD
Practice Address - Street 2:SUITE 67
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1604
Practice Address - Country:US
Practice Address - Phone:859-263-4687
Practice Address - Fax:859-264-1760
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0255106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist