1568795680 NPI number — MR. SHAWN S SMITH MS, LCPC

Table of content: MR. SHAWN S SMITH MS, LCPC (NPI 1568795680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568795680 NPI number — MR. SHAWN S SMITH MS, LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
SHAWN
Provider Middle Name:
S
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MS, LCPC
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:
1568795680
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15603 ELKLICK RD SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FROSTBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21532-3922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 S GEORGE ST STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21502-3039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-876-1290
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/08/2009

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:  LC2263 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: LC2263 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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