Organization
MARK SMITH, PROFESSIONAL SERVICES, LLC
Active
Organization
MARK SMITH, PROFESSIONAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK LESLIE SMITH L.C.S.W. (OWNER)
(816) 353-5363
Entity
Organization
Contact information
Practice address
14825 E 42ND ST S, SUITE 208, INDEPENDENCE, MO 64055-4776
(816) 353-5363
(816) 295-6100
Mailing address
14825 E 42ND ST S, SUITE 208, INDEPENDENCE, MO 64055-4776
(816) 353-5363
(816) 295-6100
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
002326
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
493295521
—
MO
Enumeration date
12/04/2008
Last updated
05/01/2014
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