Individual
BRIAN WALLACE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
3830 S CUSHMAN ST, FAIRBANKS, AK 99701-7530
(907) 455-1416
(907) 455-1460
Mailing address
1300 GARAY ST, FAIRBANKS, AK 99709-3169
(907) 687-7805
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
05/02/2011
Last updated
05/02/2011
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