Provider Demographics
NPI:1447978549
Name:SMITH, MARIAH DOREEN (MS, TLMHC)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:DOREEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, TLMHC
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:BRINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:606 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-1606
Mailing Address - Country:US
Mailing Address - Phone:563-419-2054
Mailing Address - Fax:
Practice Address - Street 1:1111 PAINE ST
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-2411
Practice Address - Country:US
Practice Address - Phone:563-419-2054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA113707101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health