1235207689 NPI number — MRS. SHIRLEY D SMITH M.S., LP.C, NCC

Table of content: MRS. SHIRLEY D SMITH M.S., LP.C, NCC (NPI 1235207689)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235207689 NPI number — MRS. SHIRLEY D SMITH M.S., LP.C, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
SHIRLEY
Provider Middle Name:
D
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., LP.C, NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANKROM-SMITH
Provider Other First Name:
SHIRLEY
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., LPC, NCC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1235207689
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 189
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEBB CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64870-0189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-839-1779
Provider Business Mailing Address Fax Number:
888-839-9210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEBB CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64870-2378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-839-1779
Provider Business Practice Location Address Fax Number:
888-839-9210
Provider Enumeration Date:
12/02/2006

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:  2005003223 , 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: SDA3992127 . This is a "CTS WITH DSS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 49284 . This is a "NBCC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 497483404 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2005003223 . This is a "LICENSED PRACTICAL COUNSE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com