Provider Demographics
NPI:1104259837
Name:SMITH, DANIEL LLOYD (BACC LCSW)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:LLOYD
Last Name:SMITH
Suffix:
Gender:M
Credentials:BACC LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 ZIPP RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:MO
Mailing Address - Zip Code:63050-1210
Mailing Address - Country:US
Mailing Address - Phone:314-265-2440
Mailing Address - Fax:
Practice Address - Street 1:11648 GRAVOIS RD STE 245
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-3034
Practice Address - Country:US
Practice Address - Phone:314-849-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC184101Y00000X
MO38921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor