Provider Demographics
NPI:1588352223
Name:ANNIKA SMITH, LCSW P.L.L.C.
Entity type:Organization
Organization Name:ANNIKA SMITH, LCSW P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OUTPATIENT MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNIKA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-890-0960
Mailing Address - Street 1:732 W MYSTIC FALLS WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-4696
Mailing Address - Country:US
Mailing Address - Phone:541-890-0960
Mailing Address - Fax:
Practice Address - Street 1:732 W MYSTIC FALLS WAY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-4696
Practice Address - Country:US
Practice Address - Phone:541-890-0960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty