MEDICARE: MS. KIMBERLY SMITH MFT LADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	0784	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285651117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY SMITH MFT LADC

Provider Business Mailing Address
First Line	:	7495 W AZURE DR STE 205
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-4416
Country	:	US
Telephone Number	:	702-515-4015
Fax Number	:	702-202-6798

Provider Business Practice Location Address
First Line	:	7495 W AZURE DR STE 205
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-4416
Country	:	US
Telephone Number	:	702-515-4015
Fax Number	:	702-202-6798

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	02/22/2020

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