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General NPI Number Information
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NPI Number | 1679939920
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Entity Type | Individual
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Provider Name | ALYCIA SMITH
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Gender | Female
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Dates
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Enumeration Date | 12/31/2015
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Last Update Date | 11/29/2022
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Provider Practice Location Address
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Address Line | 510 NE ROBERTS AVE STE 200
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City | GRESHAM
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State | OR
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Zip | 97030-7484
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Country | US
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Telephone | 971-220-2496
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Fax |
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Provider Business Mailing Address
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Address Line | 4233 SE 182ND AVE # 212
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City | GRESHAM
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State | OR
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Zip | 97030-5082
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Country | US
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Telephone | 971-220-2496
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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 | CG60615744
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW60824262
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L7466
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License Number State | OR
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