1245216837 NPI number — MR. MARK L SMITH LPC, LCSW

Table of content: MR. MARK L SMITH LPC, LCSW (NPI 1245216837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245216837 NPI number — MR. MARK L SMITH LPC, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
MARK
Provider Middle Name:
L
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LPC, LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245216837
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8003 KENWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64131-2147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-353-5363
Provider Business Mailing Address Fax Number:
816-295-6100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14825 E 42ND ST S
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64055-4776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-353-5363
Provider Business Practice Location Address Fax Number:
816-295-6100
Provider Enumeration Date:
12/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  000226 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 002326 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A958082 . This is a "VALUE OPTIONS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 34942019 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 34942 . This is a "PREFERRED HEALTH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 493295521 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: MA14787001 . This is a "MEDICARE INDIVIDUAL PTAN MA14787001" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1669617627 . This is a "GROUP NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: MA1478 . This is a "MEDICARE GROUP" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com