Provider Demographics
NPI:1821597287
Name:SMITH, DEANNA (LPC)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:SMITH
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 HUNTERS GLEN DR APT B
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-4047
Mailing Address - Country:US
Mailing Address - Phone:501-515-8446
Mailing Address - Fax:
Practice Address - Street 1:3500 N VILLAGE DR STE 264
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-4979
Practice Address - Country:US
Practice Address - Phone:816-226-6763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPMC3257101YP2500X
ARP2206018101YP2500X
SC1895101YP2500X
MO2023029165101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional