Individual
KELLY RAYE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, ACSW
Contact information
Practice address
600 CENTRAL AVE STE 208, GREAT FALLS, MT 59401
(406) 231-1775
(406) 403-0660
Mailing address
600 CENTRAL AVE STE 208, GREAT FALLS, MT 59401-3141
(406) 231-1775
(406) 403-0660
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
743-LCSW
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000071565
BLUE CROSS/SHIELD OF MONT
MT
01
—
LCSW-503
WYOMING LCSW LICENSE
WY
Enumeration date
08/10/2006
Last updated
09/24/2018
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