Provider Demographics
NPI:1316235070
Name:SMITH, STOKES (CSW, LSAC)
Entity type:Individual
Prefix:
First Name:STOKES
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:CSW, LSAC
Other - Prefix:
Other - First Name:STOKE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:STOKES SMITH
Mailing Address - Street 1:2126 E 3300 S BLDG F
Mailing Address - Street 2:BUILDING F #2126
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-2679
Mailing Address - Country:US
Mailing Address - Phone:801-870-8399
Mailing Address - Fax:
Practice Address - Street 1:1390 S 1100 E STE 203
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-2463
Practice Address - Country:US
Practice Address - Phone:801-983-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6817632-6006101YA0400X
UT6817632-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)