Healthcare Provider Details

I. General information

NPI: 1275497729
Provider Name (Legal Business Name): KEANDRA R. SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14901 E HAMPDEN AVE STE 120
AURORA CO
80014-5037
US

IV. Provider business mailing address

17815 E GREENWOOD DR UNIT 1728
AURORA CO
80013-7659
US

V. Phone/Fax

Practice location:
  • Phone: 720-975-8031
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0024178
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: