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General NPI Number Information
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NPI Number | 1609121342
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Entity Type | Individual
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Provider Name | SMITH DEBREY KRUEGER MA, LMHC
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Gender | Male
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Dates
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Enumeration Date | 07/18/2012
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 4569 KUKUI ST STE 201
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City | KAPAA
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State | HI
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Zip | 96746-1775
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Country | US
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Telephone | 541-728-3052
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Fax |
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Provider Business Mailing Address
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Address Line | 1110 NE JONES RD
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City | BEND
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State | OR
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Zip | 97701-3922
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Country | US
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Telephone | 808-631-5731
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1756-13
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MHC-375
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License Number State | HI
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