Healthcare Provider Details

I. General information

NPI: 1871755736
Provider Name (Legal Business Name): INDIA I. SMITH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRITTANY RD
WESTCLIFFE CO
81252
US

IV. Provider business mailing address

141 PARKER ST STE 306
MAYNARD MA
01754-2180
US

V. Phone/Fax

Practice location:
  • Phone: 719-458-5353
  • Fax:
Mailing address:
  • Phone: 866-991-2103
  • Fax: 267-937-3304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0013692
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number05112
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: