Provider Demographics
NPI:1790843795
Name:SMITH, LINDA M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 BEACON HILL LOOP
Mailing Address - Street 2:
Mailing Address - City:STRAFFORD
Mailing Address - State:MO
Mailing Address - Zip Code:65757
Mailing Address - Country:US
Mailing Address - Phone:417-299-7662
Mailing Address - Fax:417-736-9133
Practice Address - Street 1:843 BEACON HILL LOOP
Practice Address - Street 2:
Practice Address - City:STRAFFORD
Practice Address - State:MO
Practice Address - Zip Code:65757
Practice Address - Country:US
Practice Address - Phone:417-299-7662
Practice Address - Fax:417-736-9133
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001024800103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist