Provider Demographics
NPI:1124613005
Name:SMITH, SAMANTHA JANE (LPC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JANE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1489
Mailing Address - Country:US
Mailing Address - Phone:314-371-6500
Mailing Address - Fax:
Practice Address - Street 1:11166 TESSON FERRY RD STE 300
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-6966
Practice Address - Country:US
Practice Address - Phone:314-802-2658
Practice Address - Fax:314-842-2552
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional