Mark Smith, Professional Services, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

002326 Issued in MO

Legal business name

MARK SMITH, PROFESSIONAL SERVICES, LLC

Practice address

14825 E 42ND St S
Suite 208
Independence, MO 64055-4776

Phone

(816) 353-5363

Fax

(816) 295-6100

NPI assigned

Dec 4, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Mark Leslie Smith, L.C.S.W.

Title

Owner

Phone

(816) 353-5363

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1228348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398902400000",
    "number": "1669617627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14825 E 42ND ST S",
            "address_2": "SUITE 208",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640554776",
            "telephone_number": "816-353-5363",
            "fax_number": "816-295-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14825 E 42ND ST S",
            "address_2": "SUITE 208",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640554776",
            "telephone_number": "816-353-5363",
            "fax_number": "816-295-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK SMITH, PROFESSIONAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-04",
        "last_updated": "2014-05-01",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "LESLIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "816-353-5363",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "L.C.S.W."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MO",
            "license": "002326",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "493295521",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Independence, MO
• Providers in Independence, MO by specialty
• Community/Behavioral Health Agency in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2014; 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.