Healthcare Provider Details

I. General information

NPI: 1669869251
Provider Name (Legal Business Name): KATHY SMITH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2015
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 COMMERCE CT STE 250
LISLE IL
60532-3674
US

IV. Provider business mailing address

450 WARRENVILLE RD APT 145
LISLE IL
60532-1368
US

V. Phone/Fax

Practice location:
  • Phone: 630-857-9071
  • Fax:
Mailing address:
  • Phone: 331-280-9098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178010287
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: