Healthcare Provider Details

I. General information

NPI: 1588128151
Provider Name (Legal Business Name): CATHERINE LYNNE SMITH MC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CATHY SMITH MC, LPC

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 KLOTZ RD
BOWLING GREEN OH
43402-4820
US

IV. Provider business mailing address

1045 KLOTZ RD
BOWLING GREEN OH
43402-4820
US

V. Phone/Fax

Practice location:
  • Phone: 419-352-7588
  • Fax: 419-354-4977
Mailing address:
  • Phone: 419-352-7588
  • Fax: 419-354-4977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2204739
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: