Provider Demographics
NPI:1598071706
Name:SMITH, LYNN M (LCSW)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9724 KINGSTON PIKE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3347
Mailing Address - Country:US
Mailing Address - Phone:865-548-4484
Mailing Address - Fax:
Practice Address - Street 1:9724 KINGSTON PIKE
Practice Address - Street 2:SUITE 405
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3347
Practice Address - Country:US
Practice Address - Phone:865-548-4484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN52791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1521510Medicaid
TN1521510Medicaid