Healthcare Provider Details

I. General information

NPI: 1265072052
Provider Name (Legal Business Name): KEVIN BRUCE SMITH LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 NE RICE RD
LEES SUMMIT MO
64086-5849
US

IV. Provider business mailing address

1201 NE MOSS POINT RD
LEES SUMMIT MO
64064-2427
US

V. Phone/Fax

Practice location:
  • Phone: 816-966-0900
  • Fax: 816-347-3200
Mailing address:
  • Phone: 816-812-5380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number03149
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2021016991
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: