Healthcare Provider Details

I. General information

NPI: 1568016798
Provider Name (Legal Business Name): MELISSA DEAN SMITH LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8106 RED STONE HILL RD
LOUISVILLE KY
40214-4614
US

IV. Provider business mailing address

8106 RED STONE HILL RD
LOUISVILLE KY
40214-4614
US

V. Phone/Fax

Practice location:
  • Phone: 502-438-6460
  • Fax: 833-953-0891
Mailing address:
  • Phone: 502-438-6460
  • Fax: 833-953-0891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number252098
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number252098
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number252098
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: