Provider Demographics
NPI:1437034675
Name:CHUBB-SMITH, TAHENTAHAWI JODIE LEIGH (LMHC-P)
Entity type:Individual
Prefix:
First Name:TAHENTAHAWI
Middle Name:JODIE LEIGH
Last Name:CHUBB-SMITH
Suffix:
Gender:F
Credentials:LMHC-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 VICE RD
Mailing Address - Street 2:
Mailing Address - City:BRASHER FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13613-3139
Mailing Address - Country:US
Mailing Address - Phone:518-651-7538
Mailing Address - Fax:
Practice Address - Street 1:159 GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-2385
Practice Address - Country:US
Practice Address - Phone:518-557-4769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP136464101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health