Provider Demographics
NPI:1053807370
Name:SMITH, MARILYN ARNOLD (LPC)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:ARNOLD
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:LA
Mailing Address - Zip Code:71040-3215
Mailing Address - Country:US
Mailing Address - Phone:318-423-6675
Mailing Address - Fax:
Practice Address - Street 1:647 W 3RD ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:LA
Practice Address - Zip Code:71040-3215
Practice Address - Country:US
Practice Address - Phone:318-423-6675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6293101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional