Healthcare Provider Details

I. General information

NPI: 1851776785
Provider Name (Legal Business Name): LIBBY SMITH ED.D. PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 S. TROTTER LANE
FLAGSTAFF AZ
86005
US

IV. Provider business mailing address

711 W. WHIPPLE ROAD
FLAGSTAFF AZ
86001
US

V. Phone/Fax

Practice location:
  • Phone: 928-310-8403
  • Fax:
Mailing address:
  • Phone: 928-310-8403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: