Healthcare Provider Details

I. General information

NPI: 1265935662
Provider Name (Legal Business Name): KYMBERLY SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6509 S SANTA FE DR
LITTLETON CO
80120-2910
US

IV. Provider business mailing address

155 INVERNESS DR W STE 200
ENGLEWOOD CO
80112-5000
US

V. Phone/Fax

Practice location:
  • Phone: 303-730-8858
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0012994
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: