MEDICARE: KRISTA SMITH

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	172V00000X	Community Health Worker
3	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1356904296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA SMITH

Provider Business Mailing Address
First Line	:	1328 BELROSE RD
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-1531
Country	:	US
Telephone Number	:	740-590-5015
Fax Number	:

Provider Business Practice Location Address
First Line	:	1328 BELROSE RD
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-1531
Country	:	US
Telephone Number	:	740-590-5015
Fax Number	:

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

Provider Enumeration Date	:	04/16/2019
Last Update Date	:	06/25/2025

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Directions to “ KRISTA SMITH ” Practice Location

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