MEDICARE: LORI A SMITH PCC

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	C.0600696	OH

General Provider Information

NPI Number	:	1174812580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI A SMITH PCC

Provider Business Mailing Address
First Line	:	602 SOUTH ST
Second Line	:	STE C1-A
City	:	CHARDON
State	:	OH
Zip	:	44024-1499
Country	:	US
Telephone Number	:	216-932-2800
Fax Number	:

Provider Business Practice Location Address
First Line	:	602 SOUTH ST
Second Line	:	STE C1-A
City	:	CHARDON
State	:	OH
Zip	:	44024-1499
Country	:	US
Telephone Number	:	216-932-2800
Fax Number	:

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

Provider Enumeration Date	:	04/06/2011
Last Update Date	:	04/23/2015

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Directions to “ LORI A SMITH PCC” Practice Location

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