Provider Demographics
NPI:1053821470
Name:SMITH, KATHRYN ANN (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ANN
Other - Last Name:DOUGHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC NCC
Mailing Address - Street 1:223 PINNER LN APT 12
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-7526
Mailing Address - Country:US
Mailing Address - Phone:541-919-5156
Mailing Address - Fax:541-225-4878
Practice Address - Street 1:223 PINNER LN APT 12
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-7526
Practice Address - Country:US
Practice Address - Phone:541-919-5156
Practice Address - Fax:541-225-4878
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4954101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health