Healthcare Provider Details

I. General information

NPI: 1073770590
Provider Name (Legal Business Name): KAREN ELAINE SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 10/26/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 HAUCK DRIVE ROLLA PSYCHOLOGICAL ASSOCIATES
ROLLA MO
65401
US

IV. Provider business mailing address

1203 HAUCK DRIVE ROLLA PSYCHOLOGICAL ASSOCIATES
ROLLA MO
65401
US

V. Phone/Fax

Practice location:
  • Phone: 573-364-8330
  • Fax: 573-364-8330
Mailing address:
  • Phone: 573-364-8330
  • Fax: 573-364-8330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW000411
License Number StateMO

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: