Provider Demographics
NPI:1750051595
Name:SMITH, NATALIE J (M ED, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:M ED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3937 ABERDEEN AVE
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-3173
Mailing Address - Country:US
Mailing Address - Phone:618-531-4773
Mailing Address - Fax:
Practice Address - Street 1:3937 ABERDEEN AVE
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-3173
Practice Address - Country:US
Practice Address - Phone:618-531-4773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021014622101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional