Healthcare Provider Details

I. General information

NPI: 1861320400
Provider Name (Legal Business Name): QUENTIN SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WATERS EDGE
LOMBARD IL
60148-6429
US

IV. Provider business mailing address

2004 ALPINE WAY
PLAINFIELD IL
60586-5078
US

V. Phone/Fax

Practice location:
  • Phone: 331-425-8625
  • Fax:
Mailing address:
  • Phone:
  • 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: