Healthcare Provider Details

I. General information

NPI: 1477074243
Provider Name (Legal Business Name): EMMALEE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 08/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 COWART ST
JENA LA
71342-7060
US

IV. Provider business mailing address

842 WEST BRADFORD STREET SUITE D
JENA LA
71342
US

V. Phone/Fax

Practice location:
  • Phone: 318-992-2263
  • Fax: 318-992-2267
Mailing address:
  • Phone: 318-992-2263
  • Fax: 318-992-2267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: