Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 4122-125 | WI |
N | 101Y00000X | Counselor | 5505 | OK |
N | 101YM0800X | Mental Health Counselor | 4122-125 | WI |
N | 101YM0800X | Mental Health Counselor | 5505 | OK |
N | 101YP2500X | Professional Counselor | 180007427 | IL |
N | 101YP2500X | Professional Counselor | 4122-125 | WI |
N | 101YP2500X | Professional Counselor | 5505 | OK |
N | 103TR0400X | Rehabilitation Psychologist | 4122-125 | WI |
N | 225C00000X | Rehabilitation Counselor | 00094293 | IL |
N | 225C00000X | Rehabilitation Counselor | 00094293 | WI |
N | 225CA2400X | Assistive Technology Practitioner | 00094293 | WI |
N | 225CA2500X | Assistive Technology Supplier | 00094293 | WI |
NPI | 1043464217 |
---|---|
Provider Name | Calvin L Smith |
First Address | Bensenville, IL 60106-0208 |
Second Address | Oklahoma City, OK 73112-4279 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2008 |
Last Update Date | 26/09/2017 |