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General NPI Number Information
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NPI Number | 1184465858
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Entity Type | Individual
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Provider Name | ASHLEY BURDETTE SMITH LAC/LCPC
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Gender | Male
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Dates
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Enumeration Date | 06/05/2024
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 914 20TH ST SOUTH
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City | GREAT FALLS
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State | MT
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Zip | 59405
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Country | US
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Telephone | 406-217-6007
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Fax |
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Provider Business Mailing Address
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Address Line | 914 20TH ST SOUTH
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City | GREAT FALLS
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State | MT
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Zip | 59405
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Country | US
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Telephone | 406-217-6007
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | BBH-LCPC-LTC-71052
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | BBH-LAC-LIC-64002
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License Number State | MT
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