Provider Demographics
NPI:1255405676
Name:SMITH, BLYTHE HILARY (LCPC)
Entity type:Individual
Prefix:MS
First Name:BLYTHE
Middle Name:HILARY
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 LINCOLN HWY
Mailing Address - Street 2:SUITE # 307
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2349
Mailing Address - Country:US
Mailing Address - Phone:708-431-3520
Mailing Address - Fax:708-895-3520
Practice Address - Street 1:4440 LINCOLN HWY
Practice Address - Street 2:SUITE # 307
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2349
Practice Address - Country:US
Practice Address - Phone:708-431-3520
Practice Address - Fax:708-895-3520
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional