Provider Demographics
NPI:1346010337
Name:SMITH, HARLEY (RMHCI)
Entity type:Individual
Prefix:
First Name:HARLEY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 S ORLANDO AVE APT I12
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-6427
Mailing Address - Country:US
Mailing Address - Phone:407-923-7418
Mailing Address - Fax:
Practice Address - Street 1:1110 DOUGLAS AVE STE 2040
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2004
Practice Address - Country:US
Practice Address - Phone:407-378-5832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH25207101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health