MEDICARE: KELLY SMARTT MS, LMFT-ASSOCIATE

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	106H00000X	Marriage & Family Therapist	203361	TX

General Provider Information

NPI Number	:	1225593023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY SMARTT MS, LMFT-ASSOCIATE

Provider Business Mailing Address
First Line	:	5801 BROADMOOR DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-7830
Country	:	US
Telephone Number	:	214-552-7499
Fax Number	:

Provider Business Practice Location Address
First Line	:	5220 SPRING VALLEY RD STE 122
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-2513
Country	:	US
Telephone Number	:	469-546-9625
Fax Number	:

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

Provider Enumeration Date	:	02/05/2019
Last Update Date	:	02/05/2019

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