Provider Demographics
NPI:1285089177
Name:SMITH, STEVEN BRYANT (BS, LISAC)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:BRYANT
Last Name:SMITH
Suffix:
Gender:M
Credentials:BS, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4034 E LOS ALTOS DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-3567
Mailing Address - Country:US
Mailing Address - Phone:602-739-1414
Mailing Address - Fax:602-274-6531
Practice Address - Street 1:4034 E LOS ALTOS DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-3567
Practice Address - Country:US
Practice Address - Phone:602-739-1414
Practice Address - Fax:602-274-6531
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1354-LISAC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)