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General NPI Number Information
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NPI Number | 1558154922
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Entity Type | Organization
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Legal Business Name | KRISTA SMITH
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 6559 WILSON MILLS ROAD STE 106A
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City | MAYFIELD VILLAGE
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State | OH
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Zip | 44143-3433
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Country | US
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Telephone | 216-264-6603
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Fax |
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Provider Business Mailing Address
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Address Line | 1328 BELROSE RD
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City | MAYFIELD HEIGHTS
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State | OH
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Zip | 44124-1531
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Country | US
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Telephone | 740-590-5015
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Fax |
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | KRISTA E SMITH
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Credential | MS, LPCC-S
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Telephone | 740-590-5015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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