Individual
MR. MARK L SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC, LCSW
Contact information
Practice address
14825 E 42ND ST S, SUITE 208, INDEPENDENCE, MO 64055-4776
(816) 353-5363
(816) 295-6100
Mailing address
8003 KENWOOD AVE, KANSAS CITY, MO 64131-2147
(816) 353-5363
(816) 295-6100
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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