Individual
KATIE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1175 W PECOS RD, CHANDLER, AZ 85224-5212
(702) 561-3408
Mailing address
2852 LODGE POLE CT, NORTH LAS VEGAS, NV 89030-5213
(702) 561-3408
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
85-1717824
—
AZ
Enumeration date
07/01/2020
Last updated
07/01/2020
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