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NPI Code Detail

MEDICARE: MR. KELVIN MARTIN SMITH CIT

MEDICARE: MR. KELVIN MARTIN SMITH CIT
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
1101YA0400XAddiction (Substance Use Disorder) Counselor4238LA

General Provider Information

NPI Number : 1841853306
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KELVIN MARTIN SMITH CIT
Provider Business Mailing Address
First Line : 105 REBECCA DR
Second Line :
City : LAFAYETTE
State : LA
Zip : 70508-5965
Country : US
Telephone Number : 337-661-4245
Fax Number : 337-588-4179
Provider Business Practice Location Address
First Line : 21089 SOUTH FRONTAGE ROAD
Second Line :
City : LACASSINE
State : LA
Zip : 70650
Country : US
Telephone Number : 337-936-9197
Fax Number : 337-588-4179
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2019
Last Update Date : 04/19/2019

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