Healthcare Provider Details

I. General information

NPI: 1962939660
Provider Name (Legal Business Name): MEGAN SMITH LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2017
Last Update Date: 07/22/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4-1629 KUHIO HWY SUITE C1
KAPAA HI
96746
US

IV. Provider business mailing address

PO BOX 131
ANAHOLA HI
96703-0131
US

V. Phone/Fax

Practice location:
  • Phone: 808-400-0047
  • Fax:
Mailing address:
  • Phone: 508-314-0421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC00861
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9602
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateHI
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC525
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: