MEDICARE: MS. KIM R SMITH LMHC, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	7880	NC
2	101YM0800X	Mental Health Counselor	MH8094	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	Z090M	OTHER	FL	BLUE CROSS BLUE SHIELD #

General Provider Information

NPI Number	:	1043274186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIM R SMITH LMHC, LPC

Provider Business Mailing Address
First Line	:	908 LAKE ELSIE DR
Second Line	:
City	:	TAVARES
State	:	FL
Zip	:	32778-4978
Country	:	US
Telephone Number	:	352-409-6540
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 N HIGHWAY 27 STE 4
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-2411
Country	:	US
Telephone Number	:	352-708-6283
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	07/08/2024

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