Provider Demographics
NPI:1861525008
Name:SMITH, PATRICIA ANN (MA, LPCC)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:PATTI
Other - Middle Name:ANN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPCC
Mailing Address - Street 1:10800 CHACO TERRACE ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-6113
Mailing Address - Country:US
Mailing Address - Phone:505-480-1201
Mailing Address - Fax:505-899-9729
Practice Address - Street 1:10800 CHACO TERRACE ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-6113
Practice Address - Country:US
Practice Address - Phone:505-480-1201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0127341101YP2500X
CCMH0127341101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional