Active NPI
Tereasa Dene Smith, LMHC
- Mental Health Counselor
- Lynnwood, WA
National Provider Identifier
1619635141
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 61419489
- Practice address
- 5108 196TH St SW Ste 208
Lynnwood, WA 98036-6152 - Phone
- (425) 530-7828
- NPI assigned
- Dec 1, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 61419489 | WA | Primary |
Addresses
Primary practice location
5108 196TH St SW Ste 208
Lynnwood, WA 98036-6152
Mailing address
16300 Mill Creek Blvd Ste G1
Mill Creek, WA 98012-1279
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 11, 2024 through Jan 11, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61419489 | WA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1638316800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706572800000",
"number": "1619635141",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16300 MILL CREEK BLVD STE G1",
"city": "MILL CREEK",
"state": "WA",
"postal_code": "980121279"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5108 196TH ST SW STE 208",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "980366152",
"telephone_number": "425-530-7828"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "TEREASA",
"middle_name": "DENE",
"credential": "LMHC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-12-01",
"last_updated": "2024-01-30",
"certification_date": "2024-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "61419489",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lynnwood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.