Healthcare Provider Details

I. General information

NPI: 1477865855
Provider Name (Legal Business Name): LYNNE MARIE SMITH MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 11/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W 16TH ST
VANCOUVER WA
98660-2791
US

IV. Provider business mailing address

PO BOX 131
VANCOUVER WA
98666-0131
US

V. Phone/Fax

Practice location:
  • Phone: 360-213-1801
  • Fax:
Mailing address:
  • Phone: 360-213-1801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH 60160372
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF 60156713
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: