MEDICARE: KIMBERLY M SMITH PHD. LMFT

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	2011017503	MO

General Provider Information

NPI Number	:	1871872432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY M SMITH PHD. LMFT

Provider Business Mailing Address
First Line	:	7292 MANCHESTER RD
Second Line	:
City	:	MAPLEWOOD
State	:	MO
Zip	:	63143-2438
Country	:	US
Telephone Number	:	314-780-1260
Fax Number	:

Provider Business Practice Location Address
First Line	:	7292 MANCHESTER RD
Second Line	:
City	:	MAPLEWOOD
State	:	MO
Zip	:	63143-2438
Country	:	US
Telephone Number	:	314-780-1260
Fax Number	:

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

Provider Enumeration Date	:	08/12/2011
Last Update Date	:	08/12/2011

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