MEDICARE: SIRI SMITHBACK 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	101YP2500X	Professional Counselor	C5405	OR

General Provider Information

NPI Number	:	1619567609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIRI SMITHBACK LPC

Provider Business Mailing Address
First Line	:	5054 BOOTH HILL RD
Second Line	:
City	:	HOOD RIVER
State	:	OR
Zip	:	97031-9400
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5054 BOOTH HILL RD
Second Line	:
City	:	HOOD RIVER
State	:	OR
Zip	:	97031-9400
Country	:	US
Telephone Number	:	608-225-6179
Fax Number	:

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

Provider Enumeration Date	:	01/22/2021
Last Update Date	:	01/17/2022

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Directions to “ SIRI SMITHBACK LPC” Practice Location

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