MEDICARE: TIMOTHY 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	08309-I	NV

General Provider Information

NPI Number	:	1518890664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY SMITH

Provider Business Mailing Address
First Line	:	3661 S MARYLAND PKWY STE 64
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3005
Country	:	US
Telephone Number	:	702-735-7900
Fax Number	:

Provider Business Practice Location Address
First Line	:	3661 S MARYLAND PKWY STE 64
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3005
Country	:	US
Telephone Number	:	702-735-7900
Fax Number	:

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

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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Directions to “ TIMOTHY SMITH ” Practice Location

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