Healthcare Provider Details

I. General information

NPI: 1013764588
Provider Name (Legal Business Name): MADISON SMITH M.S., L.A.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2024
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3506 S CULPEPPER CIR STE A
SPRINGFIELD MO
65804-4251
US

IV. Provider business mailing address

4930 W MINOTA ST APT 6
SPRINGFIELD MO
65802-6784
US

V. Phone/Fax

Practice location:
  • Phone: 417-719-1440
  • Fax:
Mailing address:
  • Phone: 479-351-0771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2026030685
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: