Healthcare Provider Details

I. General information

NPI: 1346515251
Provider Name (Legal Business Name): RANDY ALAN SMITH L.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2012
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 W HIGH ST
BELLEFONTE PA
16823-1302
US

IV. Provider business mailing address

109 GRANDVIEW ROAD
CENTRE HALL PA
16828-0602
US

V. Phone/Fax

Practice location:
  • Phone: 814-353-3151
  • Fax:
Mailing address:
  • Phone: 814-364-1278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW129264
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: