MEDICARE: RENEE SMITH

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	ADDC0000594	CA
2	106H00000X	Marriage & Family Therapist	14833	CO

General Provider Information

NPI Number	:	1235029562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE SMITH

Provider Business Mailing Address
First Line	:	1350 S CANOE CREEK DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-7757
Country	:	US
Telephone Number	:	719-439-4374
Fax Number	:

Provider Business Practice Location Address
First Line	:	5540 N ACADEMY BLVD STE 110
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3682
Country	:	US
Telephone Number	:	719-204-5112
Fax Number	:	719-982-2275

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

Provider Enumeration Date	:	07/08/2025
Last Update Date	:	07/08/2025

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Directions to “ RENEE SMITH ” Practice Location

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