Provider Demographics
NPI:1659758241
Name:SMITH, TASHA (LMFT)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7517 BEECHWOOD CENTRE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7879
Mailing Address - Country:US
Mailing Address - Phone:502-645-2641
Mailing Address - Fax:
Practice Address - Street 1:7517 BEECHWOOD CENTRE RD STE 300
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7879
Practice Address - Country:US
Practice Address - Phone:317-268-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-03
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYMFTMFT00217486106H00000X
IN35001937A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist