Healthcare Provider Details

I. General information

NPI: 1477992220
Provider Name (Legal Business Name): SUSAN KYLE SMITH LPCC, LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 MAYFAIR DR STE 409
OWENSBORO KY
42301-4570
US

IV. Provider business mailing address

2816 VEACH RD STE 208
OWENSBORO KY
42303-6299
US

V. Phone/Fax

Practice location:
  • Phone: 270-417-7980
  • Fax: 270-417-7989
Mailing address:
  • Phone: 270-228-0340
  • Fax: 270-228-0341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number171012
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number246343
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: