Healthcare Provider Details

I. General information

NPI: 1134738107
Provider Name (Legal Business Name): ANGELA M SMITH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA M BUTLER

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9510 ARBOR LN
ZACHARY LA
70791-7460
US

IV. Provider business mailing address

9510 ARBOR LN
ZACHARY LA
70791-7460
US

V. Phone/Fax

Practice location:
  • Phone: 225-454-3995
  • Fax:
Mailing address:
  • Phone: 225-454-3995
  • Fax: 225-362-5314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberPLC7918
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: