Healthcare Provider Details

I. General information

NPI: 1417174079
Provider Name (Legal Business Name): ANTHONY P SMITH LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

846 E 10TH AVE
BOWLING GREEN KY
42101-2363
US

IV. Provider business mailing address

PO BOX 51322
BOWLING GREEN KY
42102-5622
US

V. Phone/Fax

Practice location:
  • Phone: 574-344-3101
  • Fax: 270-843-5383
Mailing address:
  • Phone: 270-777-9283
  • Fax: 270-777-1550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39002284A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: