Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 01487 | MO |
Y | 103TC0700X | Clinical Psychologist | 01487 | MO |
NPI | 1003944935 |
---|---|
Provider Name | Dr. Lizette Janine Smith |
First Address | Saint Louis, MO 63146-5644 |
Second Address | Saint Louis, MO 63108-2702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2007 |
Last Update Date | 08/07/2007 |