Provider Demographics
NPI:1891181830
Name:SMITH, TRISHA (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8833 GROSS POINT RD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1859
Mailing Address - Country:US
Mailing Address - Phone:847-414-3274
Mailing Address - Fax:
Practice Address - Street 1:8833 GROSS POINT RD
Practice Address - Street 2:SUITE 309
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1859
Practice Address - Country:US
Practice Address - Phone:847-414-3274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-15-18256103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst