Provider Demographics
NPI:1740794767
Name:SMITH, GERALD (BACHELORS)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:BACHELORS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5246
Mailing Address - Country:US
Mailing Address - Phone:318-361-4482
Mailing Address - Fax:318-361-4880
Practice Address - Street 1:1020 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5246
Practice Address - Country:US
Practice Address - Phone:318-361-4482
Practice Address - Fax:318-361-4880
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health