MEDICARE: MR. DANIEL LEE SMITH M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	RC00036256	WA

General Provider Information

NPI Number	:	1134184435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL LEE SMITH M.A.

Provider Business Mailing Address
First Line	:	416 RAYE ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-1906
Country	:	US
Telephone Number	:	206-802-5916
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 GREENWOOD AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-4668
Country	:	US
Telephone Number	:	206-999-7264
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	07/08/2007

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