MEDICARE: LAURA G SMITH LAC

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		KS

General Provider Information

NPI Number	:	1912650383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA G SMITH LAC

Provider Business Mailing Address
First Line	:	9918 E HARRY ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67207-5008
Country	:	US
Telephone Number	:	131-626-0344
Fax Number	:

Provider Business Practice Location Address
First Line	:	9918 E HARRY ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67207-5008
Country	:	US
Telephone Number	:	131-626-0344
Fax Number	:

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

Provider Enumeration Date	:	01/27/2022
Last Update Date	:	01/27/2022

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Directions to “ LAURA G SMITH LAC” Practice Location

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