Healthcare Provider Details

I. General information

NPI: 1811483217
Provider Name (Legal Business Name): MARY ELIZABETH SMITH P-LPC, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY ELIZABETH GRIFFIN LAC

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9851 HIGHWAY 178 STE A
OLIVE BRANCH MS
38654-3214
US

IV. Provider business mailing address

9782 PIGEON ROOST PARK CIR
OLIVE BRANCH MS
38654-3218
US

V. Phone/Fax

Practice location:
  • Phone: 662-253-8324
  • Fax: 662-253-8336
Mailing address:
  • Phone: 870-897-7090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP-1602
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA2404008
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: