Provider Demographics
NPI:1689445553
Name:SMITH, ARIANNE
Entity Type:Individual
Prefix:
First Name:ARIANNE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 NORTHAMPTON ST # 158
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4560
Mailing Address - Country:US
Mailing Address - Phone:570-203-9222
Mailing Address - Fax:570-203-9477
Practice Address - Street 1:2330 PASEO DEL PRADO STE C101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4336
Practice Address - Country:US
Practice Address - Phone:570-203-9222
Practice Address - Fax:570-203-9477
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4539106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist