Healthcare Provider Details

I. General information

NPI: 1477018562
Provider Name (Legal Business Name): FAREN CHANDLER SMITH MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 02/17/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3754 W INDIAN TRAIL RD
SPOKANE WA
99208-4700
US

IV. Provider business mailing address

11826 N MAYFAIR RD APT 34
SPOKANE WA
99218-1863
US

V. Phone/Fax

Practice location:
  • Phone: 509-559-3100
  • Fax:
Mailing address:
  • Phone: 509-386-6520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSC60902329
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC60902329
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: