Provider Demographics
NPI:1568457737
Name:SMITH, LINDA C (LMFT LMHC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMFT LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6413 CONSTITUTION DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-1549
Mailing Address - Country:US
Mailing Address - Phone:260-755-5495
Mailing Address - Fax:260-755-5947
Practice Address - Street 1:6413 CONSTITUTION DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-1549
Practice Address - Country:US
Practice Address - Phone:260-755-5495
Practice Address - Fax:260-755-5947
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001446A106H00000X
IN39000209A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
267336000OtherMAGELLAN BEHAVIORAL HEALT
000000311148OtherANTHEM
0007789215OtherAETNA US HEALTHCARE
2043493OtherCIGNA