Healthcare Provider Details

I. General information

NPI: 1356486799
Provider Name (Legal Business Name): DONALEE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 W 11TH AVE 290
EUGENE OR
97402-3758
US

IV. Provider business mailing address

87860 TERRITORIAL RD #73
VENETA OR
97487-9764
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-1262
  • Fax: 541-626-0359
Mailing address:
  • Phone: 541-228-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: