Provider Demographics
NPI:1114464013
Name:SMITH, KENDALL R E (MA, LPC)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:R E
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2595 COUNTY ROAD 203
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-6134
Mailing Address - Country:US
Mailing Address - Phone:303-817-6122
Mailing Address - Fax:
Practice Address - Street 1:2595 COUNTY ROAD 203
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-6134
Practice Address - Country:US
Practice Address - Phone:303-817-6122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0012003101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional