Provider Demographics
NPI:1629193198
Name:SMITH, LAURIE J (PHD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 462
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-2413
Mailing Address - Country:US
Mailing Address - Phone:509-595-5225
Mailing Address - Fax:509-334-5515
Practice Address - Street 1:1256 SE BISHOP BOULEVARD
Practice Address - Street 2:SUITE M
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-2413
Practice Address - Country:US
Practice Address - Phone:509-595-5225
Practice Address - Fax:509-334-5515
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1626103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical