Provider Demographics
NPI:1699078097
Name:SMITH, EDWARD LYNN (MS LMHC CAP)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:M
Credentials:MS LMHC CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1179 NW 97TH DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-5962
Mailing Address - Country:US
Mailing Address - Phone:954-464-4673
Mailing Address - Fax:
Practice Address - Street 1:1179 NW 97TH DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-5962
Practice Address - Country:US
Practice Address - Phone:954-464-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP1405101YA0400X
FLMH2805101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)