MEDICARE: SALLY D SMITH LCSW, LMHP

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	1041C0700X	Clinical Social Worker	1573	NE
2	101YM0800X	Mental Health Counselor	4540	NE

General Provider Information

NPI Number	:	1689991325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY D SMITH LCSW, LMHP

Provider Business Mailing Address
First Line	:	908 N HOWARD AVE STE 102
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-3529
Country	:	US
Telephone Number	:	308-398-6050
Fax Number	:	308-398-6051

Provider Business Practice Location Address
First Line	:	308 N LOCUST ST STE 401
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68801-5901
Country	:	US
Telephone Number	:	402-225-6360
Fax Number	:	402-988-1565

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

Provider Enumeration Date	:	04/20/2010
Last Update Date	:	04/30/2025

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