Healthcare Provider Details

I. General information

NPI: 1700163896
Provider Name (Legal Business Name): CYNTHIA NICOLE SMOOT LPC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 VANDIVER DR STE 100
COLUMBIA MO
65202-3754
US

IV. Provider business mailing address

PO BOX 7953
COLUMBIA MO
65205-7953
US

V. Phone/Fax

Practice location:
  • Phone: 573-825-3455
  • Fax: 573-875-0371
Mailing address:
  • Phone: 573-825-3455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2012034692
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2011036958
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: