Provider Demographics
NPI:1043464217
Name:SMITH, CALVIN L (LCPC, LPC)
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:L
Last Name:SMITH
Suffix:
Gender:M
Credentials:LCPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60106-0208
Mailing Address - Country:US
Mailing Address - Phone:630-694-0446
Mailing Address - Fax:877-822-7631
Practice Address - Street 1:3000 UNITED FOUNDERS BLVD STE 225D
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4279
Practice Address - Country:US
Practice Address - Phone:405-821-8182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5505101Y00000X, 101YM0800X, 101YP2500X
WI4122-125101YM0800X, 101YP2500X, 103TR0400X, 101Y00000X
IL180007427101YP2500X, 101YP2500X
171M00000X, 172V00000X
WI00094293225C00000X, 225CA2400X, 225CA2500X
IL00094293225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Practitioner
No225CA2500XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Supplier