MEDICARE: KATHERINE M SMITH LPC, CPC

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	LPC 11118	AZ
2	101YP2500X	Professional Counselor	CP1253-R	NV

General Provider Information

NPI Number	:	1093894610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE M SMITH LPC, CPC

Provider Business Mailing Address
First Line	:	743 PORTO MIO WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-6016
Country	:	US
Telephone Number	:	520-249-3470
Fax Number	:

Provider Business Practice Location Address
First Line	:	743 PORTO MIO WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-6016
Country	:	US
Telephone Number	:	520-249-3470
Fax Number	:

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

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	08/18/2023

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