Provider Demographics
NPI:1548386311
Name:BERTENTHAL-SMITH, JUDITH (LPC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:BERTENTHAL-SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 PINEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-9556
Mailing Address - Country:US
Mailing Address - Phone:304-636-7623
Mailing Address - Fax:304-637-1482
Practice Address - Street 1:1002 S DAVIS AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3528
Practice Address - Country:US
Practice Address - Phone:304-636-7623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV524101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional