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NPI Code Detail

MEDICARE: KENNETH E. SMITH

MEDICARE: KENNETH E. SMITH
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1417260878
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH E. SMITH
Provider Business Mailing Address
First Line : PO BOX 134
Second Line :
City : BAYSIDE
State : CA
Zip : 95524-0134
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2413 2ND ST
Second Line :
City : EUREKA
State : CA
Zip : 95501-0811
Country : US
Telephone Number : 707-269-9590
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2010
Last Update Date : 07/14/2010

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