Provider Demographics
NPI:1023600442
Name:SMITH, SHANTRAY LENAY (LPC-S)
Entity type:Individual
Prefix:MRS
First Name:SHANTRAY
Middle Name:LENAY
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 WOODALE DR APT 74
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2798
Mailing Address - Country:US
Mailing Address - Phone:318-503-9214
Mailing Address - Fax:
Practice Address - Street 1:325 WOODALE DR APT 74
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2798
Practice Address - Country:US
Practice Address - Phone:318-503-9214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5058101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional