Healthcare Provider Details

I. General information

NPI: 1962315077
Provider Name (Legal Business Name): KANDY M. SMITH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 S 5TH ST STE 398
SAINT CHARLES MO
63301-2447
US

IV. Provider business mailing address

1360 S 5TH ST STE 398
SAINT CHARLES MO
63301-2447
US

V. Phone/Fax

Practice location:
  • Phone: 314-435-5253
  • Fax: 314-558-1839
Mailing address:
  • Phone: 314-435-5253
  • Fax: 314-558-1839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: KANDY M. SMITH
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 314-435-5253