Provider Demographics
NPI:1134969983
Name:SMITH, ALLIE ANN (TLMHC)
Entity type:Individual
Prefix:
First Name:ALLIE
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHARITON
Mailing Address - State:IA
Mailing Address - Zip Code:50049-1341
Mailing Address - Country:US
Mailing Address - Phone:641-203-7199
Mailing Address - Fax:
Practice Address - Street 1:1711 OSCEOLA AVE
Practice Address - Street 2:
Practice Address - City:CHARITON
Practice Address - State:IA
Practice Address - Zip Code:50049-1516
Practice Address - Country:US
Practice Address - Phone:641-774-8484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA125417101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health