Provider Demographics
NPI:1841054459
Name:SMITH, GORDON A (LMAC)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:LMAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 S PATTIE AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-1719
Mailing Address - Country:US
Mailing Address - Phone:316-400-6863
Mailing Address - Fax:620-322-0272
Practice Address - Street 1:2201 SE 25TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66605-1734
Practice Address - Country:US
Practice Address - Phone:316-283-6743
Practice Address - Fax:785-215-6087
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01180101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)