Provider Demographics
NPI:1235207689
Name:SMITH, SHIRLEY D (MS, LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:DAWN
Other - Last Name:ANKROM-SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LPC, NCC
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:WEBB CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64870-0189
Mailing Address - Country:US
Mailing Address - Phone:417-839-1779
Mailing Address - Fax:888-839-9210
Practice Address - Street 1:37 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WEBB CITY
Practice Address - State:MO
Practice Address - Zip Code:64870-2378
Practice Address - Country:US
Practice Address - Phone:417-839-1779
Practice Address - Fax:888-839-9210
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005003223101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOSDA3992127OtherCTS WITH DSS
MO49284OtherNBCC
MO497483404Medicaid
MO2005003223OtherLICENSED PRACTICAL COUNSE