Provider Demographics
NPI:1003549726
Name:SMITH, LANYAIRD ANTHONY (MA)
Entity type:Individual
Prefix:MR
First Name:LANYAIRD
Middle Name:ANTHONY
Last Name:SMITH
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 S INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1206
Mailing Address - Country:US
Mailing Address - Phone:773-398-4810
Mailing Address - Fax:
Practice Address - Street 1:5720 S INDIANA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1206
Practice Address - Country:US
Practice Address - Phone:773-398-4810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health