Provider Demographics
NPI:1669063129
Name:SMITH, ALI (LPC)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 627
Mailing Address - Street 2:
Mailing Address - City:PICABO
Mailing Address - State:ID
Mailing Address - Zip Code:83348-0627
Mailing Address - Country:US
Mailing Address - Phone:208-917-3694
Mailing Address - Fax:
Practice Address - Street 1:631 SECOND ST EAST
Practice Address - Street 2:SUITE 201
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340
Practice Address - Country:US
Practice Address - Phone:208-917-3694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-7996101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional