Individual
MR. MARK L SMITH
Active
Individual
MR. MARK L SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC, LCSW
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
000226
MO
1041C0700X
Clinical Social Worker
Primary
002326
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1669617627
GROUP NPI
—
01
—
34942
PREFERRED HEALTH
MO
01
—
34942019
BLUE CROSS BLUE SHIELD
MO
05
—
493295521
—
MO
01
—
A958082
VALUE OPTIONS
MO
01
—
MA1478
MEDICARE GROUP
—
01
—
MA14787001
MEDICARE INDIVIDUAL PTAN MA14787001
—
Enumeration date
12/16/2005
Last updated
08/25/2014
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