Lisa Mardel Smith

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CTB-2023-0939 Issued in NM

Practice address

1122 Central Ave SW
Albuquerque, NM 87102-2947

Phone

(505) 639-5916

NPI assigned

Feb 15, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wild Magnolia Wellness

  • Community/Behavioral Health Agency
  • Los Ranchos, NM
  • NPI 1255820205
  NPD
• Bryan Baisinger, PC

  • Chiropractor
  • Portland, OR
  • NPI 1083754659
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1297728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699833600000",
    "number": "1366749004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 SAN ANDRES AVE NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871073950",
            "telephone_number": "505-639-5916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1122 CENTRAL AVE SW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871022947",
            "telephone_number": "505-639-5916"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1201 SW 12th Ave Ste 205",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972052035",
            "country_code": "US",
            "telephone_number": "503-279-0205",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "LISA",
        "middle_name": "MARDEL",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-02-15",
        "last_updated": "2023-11-13",
        "certification_date": "2023-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "OR",
            "license": "17178",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NM",
            "license": "CTB-2023-0939",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly D Smith, CNNP
• Kristina Smith, APRN
• Laura Lee Smith
• Laura Louise Smith, PH.D.
• Linda Ann Smith, M.D.
• Lisa Marie Smith, B.A.
• Marcus Smith
• Marcy Smith, CNP
• Mark Smith, SW
• Mark Alan Smith, A.R.N.P.

• All providers in Albuquerque, NM
• Mental Health Counselor in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.