MEDICARE: MR. PATRICK L SMITH LPC

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		GA
2	101YP2500X	Professional Counselor	LPC011899	GA

General Provider Information

NPI Number	:	1174121941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK L SMITH LPC

Provider Business Mailing Address
First Line	:	117 DOVE LN
Second Line	:
City	:	LEESBURG
State	:	GA
Zip	:	31763-6211
Country	:	US
Telephone Number	:	229-291-7283
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 DOVE LN
Second Line	:
City	:	LEESBURG
State	:	GA
Zip	:	31763-6211
Country	:	US
Telephone Number	:	229-291-7283
Fax Number	:

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

Provider Enumeration Date	:	10/14/2020
Last Update Date	:	06/18/2026

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