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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