Healthcare Provider Details

I. General information

NPI: 1700194933
Provider Name (Legal Business Name): KRISTEN MARIE SMITH LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 SW MARTIN LUTHER KING JR AVE
OCALA FL
34471-1435
US

IV. Provider business mailing address

5664 SW 60TH AVE
OCALA FL
34474-5677
US

V. Phone/Fax

Practice location:
  • Phone: 352-351-6900
  • Fax: 352-291-6991
Mailing address:
  • Phone: 352-291-5555
  • Fax: 352-291-5582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH7619
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: