Provider Demographics
NPI:1386366920
Name:SMITH, EMILY GRACE (PCLC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:GRACE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3740 GRECIAN WAY
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-7223
Mailing Address - Country:US
Mailing Address - Phone:406-927-7890
Mailing Address - Fax:
Practice Address - Street 1:208 N BROADWAY STE 423
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-1943
Practice Address - Country:US
Practice Address - Phone:406-896-8427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT57317101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty