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General NPI Number Information
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NPI Number | 1154995140
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Entity Type | Individual
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Provider Name | AUSTIN SMITH LCSW
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Gender | Male
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Dates
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Enumeration Date | 05/14/2021
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | 405 N BEAVER ST STE 10
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-4500
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Country | US
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Telephone | 928-286-7229
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Fax |
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Provider Business Mailing Address
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Address Line | 6412 N SNOWFLAKE DR
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City | FLAGSTAFF
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State | AZ
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Zip | 86004-2636
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Country | US
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Telephone | 928-533-5982
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | LMSW-18770
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License Number State | AZ
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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 | LCSW-21800
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License Number State | AZ
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