MEDICARE: MS. NICOLE REGINA SMITH LMHC

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	MH22361	FL
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YM0800X	Mental Health Counselor
4	101YP2500X	Professional Counselor	MH22361
5	101YS0200X	School Counselor	MH22361	FL
6	101YM0800X	Mental Health Counselor	MH22361	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MH22361	OTHER	FL	FLORIDA DEPARTMENT OF HEALTH

General Provider Information

NPI Number	:	1730511759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NICOLE REGINA SMITH LMHC

Provider Business Mailing Address
First Line	:	700 S ROSEMARY AVE STE 204-A40
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-6313
Country	:	US
Telephone Number	:	321-662-0839
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 S ROSEMARY AVE STE 204-A40
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-6313
Country	:	US
Telephone Number	:	321-662-0839
Fax Number	:

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

Provider Enumeration Date	:	08/01/2013
Last Update Date	:	10/27/2023

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