Provider Demographics
NPI:1598974370
Name:SMITH, MONA RILEY (MFT)
Entity Type:Individual
Prefix:MS
First Name:MONA
Middle Name:RILEY
Last Name:SMITH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2635 MOUNT PLEASANT ST
Mailing Address - Street 2:#103
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-2194
Mailing Address - Country:US
Mailing Address - Phone:319-752-5295
Mailing Address - Fax:319-752-5295
Practice Address - Street 1:610 N 4TH ST
Practice Address - Street 2:#125
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-5055
Practice Address - Country:US
Practice Address - Phone:319-752-5295
Practice Address - Fax:319-752-5295
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMY17589106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist