Provider Demographics
NPI:1356564314
Name:SMITH, AMBER DAWN (MS, LMFT)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:DAWN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 11TH ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-4511
Mailing Address - Country:US
Mailing Address - Phone:620-603-6257
Mailing Address - Fax:620-603-6259
Practice Address - Street 1:1819 11TH ST
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-4511
Practice Address - Country:US
Practice Address - Phone:620-603-6257
Practice Address - Fax:620-603-6259
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS636106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist