MEDICARE: STEVEN SMITH JR.

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	101YM0800X	Mental Health Counselor	IC-1705	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	:	1295007813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN SMITH JR.

Provider Business Mailing Address
First Line	:	3085 S JONES BLVD STE D
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6767
Country	:	US
Telephone Number	:	702-888-0036
Fax Number	:

Provider Business Practice Location Address
First Line	:	3085 S JONES BLVD STE D
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6767
Country	:	US
Telephone Number	:	702-888-0036
Fax Number	:

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

Provider Enumeration Date	:	01/27/2012
Last Update Date	:	04/29/2021

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