Provider Demographics
NPI:1578850400
Name:SANTOS-SMITH, CHRISTA (LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:
Last Name:SANTOS-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 1:1012 HOMERUN ST
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-1616
Mailing Address - Country:US
Mailing Address - Phone:208-232-9430
Mailing Address - Fax:208-232-8001
Practice Address - Street 1:845 W CENTER ST
Practice Address - Street 2:SUITE C
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-4205
Practice Address - Country:US
Practice Address - Phone:208-478-4642
Practice Address - Fax:208-232-8001
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-860101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDLPC-960OtherBUREAU OF OCCUPATIONAL LICENSES