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General NPI Number Information
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NPI Number | 1366923641
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Entity Type | Organization
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Legal Business Name | KARLA SMITH FOUNDATION
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Dates
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Enumeration Date | 08/24/2018
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Last Update Date | 08/24/2018
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Provider Practice Location Address
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Address Line | 200 N LINCOLN AVE
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City | O FALLON
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State | IL
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Zip | 62269-1415
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Country | US
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Telephone | 618-624-5771
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Fax | 618-206-6508
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Provider Business Mailing Address
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Address Line | 200 N LINCOLN AVE
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City | O FALLON
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State | IL
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Zip | 62269-1415
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Country | US
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Telephone | 618-624-5771
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Fax | 618-206-6508
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. EMILY M SMITH
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Credential |
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Telephone | 618-624-5771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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