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General NPI Number Information
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NPI Number | 1104259837
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Entity Type | Individual
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Provider Name | DANIEL LLOYD SMITH BACC LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/16/2013
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Last Update Date | 08/16/2013
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Provider Practice Location Address
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Address Line | 11648 GRAVOIS RD STE 245
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City | SAINT LOUIS
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State | MO
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Zip | 63126-3034
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Country | US
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Telephone | 314-849-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 98 ZIPP RD
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City | HILLSBORO
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State | MO
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Zip | 63050-1210
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Country | US
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Telephone | 314-265-2440
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 184
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3892
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License Number State | MO
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