Healthcare Provider Details

I. General information

NPI: 1649187212
Provider Name (Legal Business Name): HEATHER MICHELLE SMOTHERS BCBA,LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 KOEHLER DR
LEBANON KY
40033-9388
US

IV. Provider business mailing address

317 KOEHLER DR
LEBANON KY
40033-9388
US

V. Phone/Fax

Practice location:
  • Phone: 270-321-4198
  • Fax:
Mailing address:
  • Phone: 270-321-4198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number300096
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: