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General NPI Number Information
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NPI Number | 1235485509
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Entity Type | Individual
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Provider Name | DANA LYN SMITH MSW, MHP,LICSW, CMHS
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Gender | Female
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Dates
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Enumeration Date | 07/24/2012
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Last Update Date | 04/10/2017
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Provider Practice Location Address
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Address Line | 714 E EDISON AVE SUITE B
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City | SUNNYSIDE
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State | WA
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Zip | 98944-2204
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Country | US
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Telephone | 509-515-0420
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Fax | 509-515-0422
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Provider Business Mailing Address
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Address Line | 714 E EDISON AVE SUITE B
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City | SUNNYSIDE
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State | WA
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Zip | 98944-2204
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Country | US
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Telephone | 509-515-0420
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Fax | 509-515-0422
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW00009250
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License Number State | WA
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