Provider Demographics
NPI:1912299876
Name:SMITH, E DENISE (MA, PLPC)
Entity Type:Individual
Prefix:MRS
First Name:E
Middle Name:DENISE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13125 MASON BEND LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8531
Mailing Address - Country:US
Mailing Address - Phone:314-504-3828
Mailing Address - Fax:
Practice Address - Street 1:18614 WHISKEY CREEK RD
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63069-2530
Practice Address - Country:US
Practice Address - Phone:314-504-3828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional