Provider Demographics
NPI:1538681135
Name:SMITH, TANYA EVETTE (MS, LMHC)
Entity type:Individual
Prefix:MS
First Name:TANYA
Middle Name:EVETTE
Last Name:SMITH
Suffix:
Gender:
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 KATHY ST
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-6039
Mailing Address - Country:US
Mailing Address - Phone:386-333-4077
Mailing Address - Fax:
Practice Address - Street 1:1420 MASON AVE STE 110
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5507
Practice Address - Country:US
Practice Address - Phone:386-274-5786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-14
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18196101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty