MEDICARE: ETHAN SMITH PLPC

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
1	101YM0800X	Mental Health Counselor	LPC9975	LA

General Provider Information

NPI Number	:	1326893082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ETHAN SMITH PLPC

Provider Business Mailing Address
First Line	:	7520 PERKINS RD STE 180B
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-9111
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7520 PERKINS RD STE 180B
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-9111
Country	:	US
Telephone Number	:	225-307-0166
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2024
Last Update Date	:	02/19/2026

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