Individual
RYAN MARK SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S.
Contact information
Practice address
2705 E 17TH ST, AMMON, ID 83406-6601
(208) 346-7500
Mailing address
2705 E 17TH ST, AMMON, ID 83406-6601
(208) 346-7500
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LPC-6566
ID
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/28/2011
Last updated
03/03/2021
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