Healthcare Provider Details

I. General information

NPI: 1659948669
Provider Name (Legal Business Name): KATHLEEN MARIAN SMITH LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8039 BROADMOOR RD STE 12
MENTOR OH
44060-7577
US

IV. Provider business mailing address

8039 BROADMOOR RD STE 12
MENTOR OH
44060-7577
US

V. Phone/Fax

Practice location:
  • Phone: 440-525-2342
  • Fax: 440-207-9129
Mailing address:
  • Phone: 440-525-2342
  • Fax: 440-207-9129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2505099
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: