Healthcare Provider Details

I. General information

NPI: 1538841036
Provider Name (Legal Business Name): AUBRIE RUTH SMITH MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4038 CANAL ST
NEW ORLEANS LA
70119-6021
US

IV. Provider business mailing address

607 FARRINGTON DR
MARRERO LA
70072-2220
US

V. Phone/Fax

Practice location:
  • Phone: 504-681-7030
  • Fax:
Mailing address:
  • Phone: 504-330-0883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLC9768
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: