Healthcare Provider Details

I. General information

NPI: 1043274186
Provider Name (Legal Business Name): KIM R SMITH LMHC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N HIGHWAY 27 STE 4
CLERMONT FL
34711-2411
US

IV. Provider business mailing address

908 LAKE ELSIE DR
TAVARES FL
32778-4978
US

V. Phone/Fax

Practice location:
  • Phone: 352-708-6283
  • Fax:
Mailing address:
  • Phone: 352-409-6540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7880
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH8094
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: