Provider Demographics
NPI:1841792785
Name:SMITH, MARK DANNER (LISW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:DANNER
Last Name:SMITH
Suffix:
Gender:M
Credentials:LISW
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 1453
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-1453
Mailing Address - Country:US
Mailing Address - Phone:641-752-5421
Mailing Address - Fax:641-752-7211
Practice Address - Street 1:9 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-1836
Practice Address - Country:US
Practice Address - Phone:641-752-5421
Practice Address - Fax:641-752-7211
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00578101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)