Provider Demographics
NPI:1962828988
Name:SMITH, LORI (LPC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13151 N 71ST DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-6001
Mailing Address - Country:US
Mailing Address - Phone:623-910-1067
Mailing Address - Fax:
Practice Address - Street 1:13460 N 94TH DR
Practice Address - Street 2:STE. J2
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4835
Practice Address - Country:US
Practice Address - Phone:623-910-1067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14163101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional