Healthcare Provider Details

I. General information

NPI: 1790844264
Provider Name (Legal Business Name): SARAH BETH SMITH LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 E SOUTHPORT RD 100
INDIANAPOLIS IN
46227-8592
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 317-783-8383
  • Fax: 317-782-6929
Mailing address:
  • Phone: 317-528-4868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39002058A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: