Provider Demographics
NPI:1215170634
Name:SMITH, TORRI S (LPC)
Entity type:Individual
Prefix:
First Name:TORRI
Middle Name:S
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 1:2806 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-2825
Mailing Address - Country:US
Mailing Address - Phone:309-781-5227
Mailing Address - Fax:309-796-3085
Practice Address - Street 1:1040 AVENUE OF THE CITIES LOT 10
Practice Address - Street 2:
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244-4164
Practice Address - Country:US
Practice Address - Phone:309-269-3100
Practice Address - Fax:309-796-3085
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
IL178.005169101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist