Provider Demographics
NPI:1588010789
Name:SMITH, STEPHEN (LMHC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 S ZINTEL WAY STE 120
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-5097
Mailing Address - Country:US
Mailing Address - Phone:509-591-0462
Mailing Address - Fax:
Practice Address - Street 1:3801 S ZINTEL WAY STE 120
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337-5097
Practice Address - Country:US
Practice Address - Phone:509-591-0462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60150620101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health