Provider Demographics
NPI:1932924305
Name:SMITH, AUDRA
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8635 PLEASANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:CROSS PLAINS
Mailing Address - State:TN
Mailing Address - Zip Code:37049-4892
Mailing Address - Country:US
Mailing Address - Phone:254-722-0427
Mailing Address - Fax:
Practice Address - Street 1:8635 PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:CROSS PLAINS
Practice Address - State:TN
Practice Address - Zip Code:37049-4892
Practice Address - Country:US
Practice Address - Phone:254-722-0427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health