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NPI Code Detail

MEDICARE: BREONA SMITH LPC

MEDICARE: BREONA 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
1101YM0800XMental Health CounselorLPC-17488AZ

General Provider Information

NPI Number : 1326528795
Entity Type Code : Individual
Provider Name (Legal Business Name) : BREONA SMITH LPC
Provider Business Mailing Address
First Line : 19426 N 36TH WAY
Second Line :
City : PHOENIX
State : AZ
Zip : 85050-3907
Country : US
Telephone Number : 602-570-1733
Fax Number :
Provider Business Practice Location Address
First Line : 4420 S 32ND ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85040-2804
Country : US
Telephone Number : 602-268-8748
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2018
Last Update Date : 08/15/2018

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Directions to “ BREONA SMITH LPC” Practice Location

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