Provider Demographics
NPI:1891921748
Name:SMITH, JEREMIAH CODY (LMHC)
Entity Type:Individual
Prefix:MR
First Name:JEREMIAH
Middle Name:CODY
Last Name:SMITH
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-7004
Mailing Address - Country:US
Mailing Address - Phone:561-683-4778
Mailing Address - Fax:561-683-9995
Practice Address - Street 1:2001 W BLUE HERON BLVD
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-5003
Practice Address - Country:US
Practice Address - Phone:561-841-3500
Practice Address - Fax:561-844-3577
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10523101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health