Healthcare Provider Details

I. General information

NPI: 1326102104
Provider Name (Legal Business Name): KAREN LEE SMITH PSY .D. LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24109 W LOCKPORT ST
PLAINFIELD IL
60544-2900
US

IV. Provider business mailing address

24109 W LOCKPORT ST
PLAINFIELD IL
60544-2900
US

V. Phone/Fax

Practice location:
  • Phone: 815-258-7099
  • Fax:
Mailing address:
  • Phone: 815-258-7099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180-005515
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: