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NPI Code Detail

MEDICARE: LISA MARIE SMITH MAC, LPC

MEDICARE: LISA MARIE SMITH MAC, LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1023658887
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA MARIE SMITH MAC, LPC
Provider Business Mailing Address
First Line : 8125 PARKWOOD DR
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63123-4830
Country : US
Telephone Number : 314-406-8193
Fax Number :
Provider Business Practice Location Address
First Line : 4121 UNION RD STE 225
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63129-1093
Country : US
Telephone Number : 314-406-8193
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2020
Last Update Date : 01/09/2020

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Directions to “ LISA MARIE SMITH MAC, LPC” Practice Location

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