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General NPI Number Information
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NPI Number | 1568457737
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Entity Type | Individual
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Provider Name | LINDA C SMITH LMFT LMHC
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Gender | Female
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Dates
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Enumeration Date | 09/14/2005
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Last Update Date | 10/27/2017
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Provider Practice Location Address
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Address Line | 6413 CONSTITUTION DR
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City | FORT WAYNE
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State | IN
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Zip | 46804-1549
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Country | US
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Telephone | 260-755-5495
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Fax | 260-755-5947
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Provider Business Mailing Address
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Address Line | 6413 CONSTITUTION DR
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City | FORT WAYNE
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State | IN
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Zip | 46804-1549
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Country | US
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Telephone | 260-755-5495
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Fax | 260-755-5947
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 35001446A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 39000209A
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License Number State | IN
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