| Doctor Name: | MS. JODI SMITH |
| NPI Number: | 1053755967 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | LPC-4450 |
| Business Practice Address: | 2201 Ironwood Pl Coeur D Alene, ID - 838142670 |
| Business Phone Number: | 2087694222 |
| Business Fax Number: | 2086677557 |
| Mailing Address: | 2673 W Bolivar Ave, COEUR D ALENE |
| State: | ID |
| Postal Code: | 838159761 |
| Phone Number: | 2086591705 |
| Fax Number: | 2086677557 |
| NPI Enumeration Date: | 04/22/2013 |
| NPI Last Update Date: | 04/22/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LPC-4450 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |