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NPI Code Detail

MEDICARE: DESILYNN G SMITH MS, LPC, ICS, CSAC

MEDICARE: DESILYNN G SMITH MS, LPC, ICS, CSAC
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
1101YP2500XProfessional Counselor
2101YA0400XAddiction (Substance Use Disorder) Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629329404
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESILYNN G SMITH MS, LPC, ICS, CSAC
Provider Business Mailing Address
First Line : 8444 N 90TH ST STE 100
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85258-4437
Country : US
Telephone Number : 602-248-8886
Fax Number : 602-854-0504
Provider Business Practice Location Address
First Line : 7600 W CAPITOL DR
Second Line :
City : MILWAUKEE
State : WI
Zip : 53222-2055
Country : US
Telephone Number : 414-905-3100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2012
Last Update Date : 03/05/2026

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