Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 7971378-6004 | UT |
N | 101YP1600X | Pastoral Counselor | ||
N | 101YP2500X | Professional Counselor | 7971378-6004 | UT |
NPI | 1053538975 |
---|---|
Provider Name | Charles R Smith |
First Address | Ogden, UT 84402-6332 |
Second Address | Ogden, UT 84401-3773 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 24/12/2018 |