Provider Demographics
NPI:1861601742
Name:SMITH, REBECCA ANN (LPCMHSP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPCMHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3692 TRACY RD
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:TN
Mailing Address - Zip Code:38004-7250
Mailing Address - Country:US
Mailing Address - Phone:901-251-4835
Mailing Address - Fax:
Practice Address - Street 1:3320 BROTHER BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-8950
Practice Address - Country:US
Practice Address - Phone:901-251-5000
Practice Address - Fax:901-251-5001
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000001865101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional