Healthcare Provider Details

I. General information

NPI: 1104192079
Provider Name (Legal Business Name): KARMEN SMITH LMHC, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3491 GANDY BLVD N SUITE 201
PINELLAS PARK FL
33781-2658
US

IV. Provider business mailing address

3491 GANDY BLVD N SUITE 201
PINELLAS PARK FL
33781-2658
US

V. Phone/Fax

Practice location:
  • Phone: 727-547-0607
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH 9780
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC16931
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: