Provider Demographics
NPI:1689991325
Name:SMITH, SALLY D (LCSW, LMHP)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 N LOCUST ST STE 401
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-5901
Mailing Address - Country:US
Mailing Address - Phone:402-225-6360
Mailing Address - Fax:402-988-1565
Practice Address - Street 1:308 N LOCUST ST STE 401
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-5901
Practice Address - Country:US
Practice Address - Phone:402-225-6360
Practice Address - Fax:402-988-1565
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15731041C0700X, 1041C0700X
NE4540101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical