Provider Demographics
NPI:1639614506
Name:SMITH, SHAYNA (MA, LMHCA)
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-3880
Mailing Address - Country:US
Mailing Address - Phone:574-267-7169
Mailing Address - Fax:574-269-4189
Practice Address - Street 1:990 ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-3622
Practice Address - Country:US
Practice Address - Phone:574-936-9646
Practice Address - Fax:574-935-4773
Is Sole Proprietor?:No
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88000253A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health