Provider Demographics
NPI:1801029772
Name:SMITH, JASON C (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S 1ST ST STE 160
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-5246
Mailing Address - Country:US
Mailing Address - Phone:608-977-1864
Mailing Address - Fax:608-255-2752
Practice Address - Street 1:111 S 1ST ST STE 160
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5246
Practice Address - Country:US
Practice Address - Phone:608-977-1864
Practice Address - Fax:608-255-2752
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1889106H00000X
IL166.001089106H00000X
WI949-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist