Provider Demographics
NPI:1649052986
Name:SMIDDY, AUDREY (LPC)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:SMIDDY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:NAI
Other - Middle Name:AP
Other - Last Name:SMIDDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:3071 N SWAN RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1259
Mailing Address - Country:US
Mailing Address - Phone:520-477-1440
Mailing Address - Fax:
Practice Address - Street 1:3071 N SWAN RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1259
Practice Address - Country:US
Practice Address - Phone:520-477-1440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional