Provider Demographics
NPI:1316761216
Name:SMITH, AUDREY ZELIA (MS, LAC, NCC)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:ZELIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3507 N SANTA RITA AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1838
Mailing Address - Country:US
Mailing Address - Phone:215-301-6506
Mailing Address - Fax:
Practice Address - Street 1:1430 E FORT LOWELL RD STE 210
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2366
Practice Address - Country:US
Practice Address - Phone:520-484-4879
Practice Address - Fax:520-363-1743
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-23082101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty