Healthcare Provider Details

I. General information

NPI: 1013614957
Provider Name (Legal Business Name): MARSHALL RYAN SMITH LAMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8414 E SHEA BLVD STE 101
SCOTTSDALE AZ
85260-6665
US

IV. Provider business mailing address

8414 E SHEA BLVD STE 101
SCOTTSDALE AZ
85260-6665
US

V. Phone/Fax

Practice location:
  • Phone: 480-680-0103
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number204061
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number10842
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: