Provider Demographics
NPI:1609088772
Name:SMITH, CHARLETT ANN (LPC)
Entity Type:Individual
Prefix:MS
First Name:CHARLETT
Middle Name:ANN
Last Name: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 1:21550 SW OLD KRUGER RD
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-8642
Mailing Address - Country:US
Mailing Address - Phone:503-636-4176
Mailing Address - Fax:503-625-2863
Practice Address - Street 1:23264 SW MAIN ST
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-6309
Practice Address - Country:US
Practice Address - Phone:503-636-4176
Practice Address - Fax:503-625-2863
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1430101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional