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General NPI Number Information
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NPI Number | 1972804474
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Entity Type | Individual
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Provider Name | MARIA L SMITH PMHNP-BC, C-FNP, LPC
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Gender | Female
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Dates
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Enumeration Date | 11/15/2010
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Last Update Date | 10/14/2022
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Provider Practice Location Address
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Address Line | 103 SOUTHLAKE CIR
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City | CANTON
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State | MS
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Zip | 39046-5369
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Country | US
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Telephone | 601-824-0342
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 KENWOOD PL
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City | JACKSON
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State | MS
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Zip | 39202-2432
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Country | US
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Telephone | 601-951-0493
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1056
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 902088
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 902088
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License Number State | MS
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