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General NPI Number Information
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NPI Number | 1346515251
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Entity Type | Individual
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Provider Name | RANDY ALAN SMITH L.S.W.
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Gender | Male
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Dates
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Enumeration Date | 03/12/2012
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Last Update Date | 03/12/2012
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Provider Practice Location Address
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Address Line | 206 W HIGH ST
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City | BELLEFONTE
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State | PA
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Zip | 16823-1302
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Country | US
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Telephone | 814-353-3151
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Fax |
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Provider Business Mailing Address
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Address Line | 109 GRANDVIEW ROAD
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City | CENTRE HALL
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State | PA
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Zip | 16828-0602
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Country | US
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Telephone | 814-364-1278
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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 | SW129264
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License Number State | PA
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