Healthcare Provider Details

I. General information

NPI: 1386523785
Provider Name (Legal Business Name): K DAVID SMITH COACHING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 NW WOODSON DR
GRANTS PASS OR
97526-1174
US

IV. Provider business mailing address

524 NW WOODSON DR
GRANTS PASS OR
97526-1174
US

V. Phone/Fax

Practice location:
  • Phone: 541-291-1377
  • Fax: 541-205-9431
Mailing address:
  • Phone: 541-291-1377
  • Fax: 541-205-9431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. KENNETH DAVID SMITH
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 541-291-1377