MEDICARE: KRISTI ANN SMITH LAMFT

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	1695	MN

General Provider Information

NPI Number	:	1518110964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTI ANN SMITH LAMFT

Provider Business Mailing Address
First Line	:	6160 SUMMIT DR N STE 125
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55430-2181
Country	:	US
Telephone Number	:	763-560-4860
Fax Number	:	763-503-1430

Provider Business Practice Location Address
First Line	:	6160 SUMMIT DR N STE 125
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55430-2181
Country	:	US
Telephone Number	:	763-560-4860
Fax Number	:	763-503-1430

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

Provider Enumeration Date	:	10/29/2008
Last Update Date	:	10/29/2008

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