Provider Demographics
NPI:1720458292
Name:MCCLINTON-SMITH, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MCCLINTON-SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 N BON MARCHE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-2257
Mailing Address - Country:US
Mailing Address - Phone:225-929-6355
Mailing Address - Fax:225-929-6354
Practice Address - Street 1:936 N BON MARCHE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-2257
Practice Address - Country:US
Practice Address - Phone:225-929-6355
Practice Address - Fax:225-929-6354
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-28
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health