1013037464 NPI number — MR. WALTER JAMES SMITH MA, LCPC, NCC

Table of content: MR. WALTER JAMES SMITH MA, LCPC, NCC (NPI 1013037464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013037464 NPI number — MR. WALTER JAMES SMITH MA, LCPC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
WALTER
Provider Middle Name:
JAMES
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MA, LCPC, NCC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
W.
Provider Other Middle Name:
JAMES
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, LCPC, NCC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1013037464
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1992
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RED LODGE
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59068-1992
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-672-6289
Provider Business Mailing Address Fax Number:
406-446-2114

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 HARNISH LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED LODGE
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59068-1992
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-671-6289
Provider Business Practice Location Address Fax Number:
406-446-2114
Provider Enumeration Date:
03/30/2007

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:  LCPC 40 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0252297 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 07547-0 . This is a "MT BLUECROSS BLUESHIELD" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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