MEDICARE: KIMBERLEE J SMITH CHIAGO LPC

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	101YP2500X	Professional Counselor	LPC-23186	AZ

General Provider Information

NPI Number	:	1386480960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLEE J SMITH CHIAGO LPC

Provider Business Mailing Address
First Line	:	15411 W WADDELL RD
Second Line	:	STE 102 PMB 1211
City	:	SURPRISE
State	:	AZ
Zip	:	85379-5170
Country	:	US
Telephone Number	:	623-239-3939
Fax Number	:	480-542-2239

Provider Business Practice Location Address
First Line	:	15411 W WADDELL RD
Second Line	:	STE 102 PMB 1211
City	:	SURPRISE
State	:	AZ
Zip	:	85379-5170
Country	:	US
Telephone Number	:	623-239-3939
Fax Number	:	480-542-2239

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

Provider Enumeration Date	:	07/03/2024
Last Update Date	:	10/23/2025

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