MEDICARE: CELES SMITH LCSW

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	1041C0700X	Clinical Social Worker	255556	KY

General Provider Information

NPI Number	:	1992384416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CELES SMITH LCSW

Provider Business Mailing Address
First Line	:	10401 LINN STATION RD STE 100
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-3842
Country	:	US
Telephone Number	:	502-589-8600
Fax Number	:	502-589-8745

Provider Business Practice Location Address
First Line	:	130 JOE B HALL AVE
Second Line	:
City	:	SHEPHERDSVILLE
State	:	KY
Zip	:	40165-6010
Country	:	US
Telephone Number	:	502-955-6447
Fax Number	:	502-955-7036

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

Provider Enumeration Date	:	04/02/2021
Last Update Date	:	04/02/2021

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Directions to “ CELES SMITH LCSW” Practice Location

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