Provider Demographics
NPI:1760549232
Name:SMITH, PATRICIA LEE (LPC)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3623
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38502-3623
Mailing Address - Country:US
Mailing Address - Phone:931-520-4889
Mailing Address - Fax:931-432-5183
Practice Address - Street 1:118 S. DIXIE AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38502
Practice Address - Country:US
Practice Address - Phone:931-520-4889
Practice Address - Fax:931-432-5183
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1884101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional