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NPI Code Detail

MEDICARE: MRS. TRACI LYNN SMITH LPC

MEDICARE: MRS. TRACI LYNN SMITH 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
1101YP2500XProfessional Counselor2010041801MO

General Provider Information

NPI Number : 1164726568
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TRACI LYNN SMITH LPC
Provider Business Mailing Address
First Line : 1326 NE 106TH PL
Second Line :
City : KANSAS CITY
State : MO
Zip : 64155-1742
Country : US
Telephone Number : 816-645-1990
Fax Number :
Provider Business Practice Location Address
First Line : 1326 NE 106TH PL
Second Line :
City : KANSAS CITY
State : MO
Zip : 64155-1742
Country : US
Telephone Number : 816-645-1990
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2010
Last Update Date : 12/29/2010

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