Provider Demographics
NPI:1346932431
Name:SMITH, AUGUST J (MS)
Entity type:Individual
Prefix:
First Name:AUGUST
Middle Name:J
Last Name:SMITH
Suffix:
Gender:X
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 LOMBARD ST APT 306
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-3619
Mailing Address - Country:US
Mailing Address - Phone:972-849-5459
Mailing Address - Fax:
Practice Address - Street 1:1551 PEARL ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4010
Practice Address - Country:US
Practice Address - Phone:541-517-9733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
ORR10529101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health