MEDICARE: SCOTT LOUIS SMITH MA, LISAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LISAC1224	AZ
2	101YM0800X	Mental Health Counselor	LISAC1224	AZ

General Provider Information

NPI Number	:	1740280775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT LOUIS SMITH MA, LISAC

Provider Business Mailing Address
First Line	:	925 N STAPLEY DRIVE
Second Line	:	#A
City	:	MESA
State	:	AZ
Zip	:	85203-5637
Country	:	US
Telephone Number	:	480-461-0795
Fax Number	:	480-964-2323

Provider Business Practice Location Address
First Line	:	925 N STAPLEY DR
Second Line	:	#A
City	:	MESA
State	:	AZ
Zip	:	85203-5637
Country	:	US
Telephone Number	:	480-461-0795
Fax Number	:	480-964-2323

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

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	09/11/2025

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