Basic Information
| Provider Information | |||||||||
| NPI: | 1386181170 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMOTHERS | ||||||||
| FirstName: | SUSAN | ||||||||
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| Credential: | LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 44 VANTAGE WAY | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372281513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154636658 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1305 WEST MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8556083560 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2017 | ||||||||
| LastUpdateDate: | 01/31/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 180.001401 | IL | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.