Provider Demographics
NPI:1053527929
Name:SMITH, GLADYS A (LPC,CCMHC)
Entity type:Individual
Prefix:MISS
First Name:GLADYS
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC,CCMHC
Other - Prefix:MISS
Other - First Name:GLADYS
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, CCMHC,MAC
Mailing Address - Street 1:7006 STANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-2334
Mailing Address - Country:US
Mailing Address - Phone:314-422-4651
Mailing Address - Fax:
Practice Address - Street 1:7006 STANFORD AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-2334
Practice Address - Country:US
Practice Address - Phone:314-422-4651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2086101YA0400X
MO2001029226101YM0800X
MO81701101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional