Provider Demographics
NPI:1891316907
Name:SMITH, LORI A
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 S CHAPARRAL RD
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85119-3608
Mailing Address - Country:US
Mailing Address - Phone:480-200-0881
Mailing Address - Fax:
Practice Address - Street 1:625 N PLAZA DR
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-5501
Practice Address - Country:US
Practice Address - Phone:480-474-5542
Practice Address - Fax:480-983-0896
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-18905101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional