MEDICARE: SHENEL MONIQUE SMOCK

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1508618851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHENEL MONIQUE SMOCK

Provider Business Mailing Address
First Line	:	4712 HANNIBAL ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80239-5531
Country	:	US
Telephone Number	:	404-539-8063
Fax Number	:

Provider Business Practice Location Address
First Line	:	4712 HANNIBAL ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80239-5531
Country	:	US
Telephone Number	:	720-598-1224
Fax Number	:

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

Provider Enumeration Date	:	04/02/2024
Last Update Date	:	04/02/2024

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Directions to “ SHENEL MONIQUE SMOCK ” Practice Location

Language	Start Address	Practice Location

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