Provider Demographics
NPI:1700395209
Name:SMITHSON COUNSELING LLC
Entity Type:Organization
Organization Name:SMITHSON COUNSELING LLC
Other - Org Name:ANDY SMITHSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANDREW (ANDY)
Authorized Official - Last Name:SMITHSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-312-3648
Mailing Address - Street 1:608 S 125 LN W
Mailing Address - Street 2:
Mailing Address - City:RUPERT
Mailing Address - State:ID
Mailing Address - Zip Code:83350-9660
Mailing Address - Country:US
Mailing Address - Phone:208-312-3648
Mailing Address - Fax:855-486-2316
Practice Address - Street 1:2311 PARK AVE STE 3
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-2104
Practice Address - Country:US
Practice Address - Phone:208-312-3648
Practice Address - Fax:855-486-2316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-27
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-33818261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)