Healthcare Provider Details

I. General information

NPI: 1134184435
Provider Name (Legal Business Name): DANIEL LEE SMITH M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 GREENWOOD AVE N
SEATTLE WA
98103-4668
US

IV. Provider business mailing address

416 RAYE ST
SEATTLE WA
98109-1906
US

V. Phone/Fax

Practice location:
  • Phone: 206-999-7264
  • Fax:
Mailing address:
  • Phone: 206-802-5916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberRC00036256
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: