Healthcare Provider Details

I. General information

NPI: 1184095663
Provider Name (Legal Business Name): FILLMORE LEWIS SMILEY IV LPCC, LAADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2015
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32075 PINE CONE DRIVE
RUNNING SPRINGS CA
92382-1578
US

IV. Provider business mailing address

PO BOX 1578
RUNNING SPRINGS CA
92382-1578
US

V. Phone/Fax

Practice location:
  • Phone: 909-301-0011
  • Fax:
Mailing address:
  • Phone: 909-301-0011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: