Healthcare Provider Details

I. General information

NPI: 1134458904
Provider Name (Legal Business Name): SADIE R. SMITH MA, LMFT, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S BLACK AVE
BOZEMAN MT
59715-6246
US

IV. Provider business mailing address

PO BOX 6506
BOZEMAN MT
59771-6506
US

V. Phone/Fax

Practice location:
  • Phone: 406-600-0348
  • Fax: 406-600-0348
Mailing address:
  • Phone: 406-600-0348
  • Fax: 406-600-0348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8215
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT-160
License Number StateWY
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1048
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number8031
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: