Provider Demographics
NPI:1861717332
Name:SMITH-STOTT, LYNN A (CDP)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:A
Last Name:SMITH-STOTT
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 NW 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3609
Mailing Address - Country:US
Mailing Address - Phone:503-200-3923
Mailing Address - Fax:503-241-7419
Practice Address - Street 1:709 NW EVERETT
Practice Address - Street 2:BLDG 17, STE 222
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-4060
Practice Address - Country:US
Practice Address - Phone:503-226-4060
Practice Address - Fax:503-445-4913
Is Sole Proprietor?:No
Enumeration Date:2010-03-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00006104101YA0400X
OR10-12-80101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health