Provider Demographics
NPI:1952661530
Name:THAXTON-SMITH, LOURENE PIKE (LPC)
Entity Type:Individual
Prefix:MS
First Name:LOURENE
Middle Name:PIKE
Last Name:THAXTON-SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:LOURENE
Other - Middle Name:PIKE
Other - Last Name:THAXTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD
Mailing Address - Street 1:829 HALBERT ST
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-2607
Mailing Address - Country:US
Mailing Address - Phone:501-332-4400
Mailing Address - Fax:501-332-4403
Practice Address - Street 1:829 HALBERT ST
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-2607
Practice Address - Country:US
Practice Address - Phone:501-332-4400
Practice Address - Fax:501-332-4403
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1609130101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1952661530Medicaid