Provider Demographics
NPI:1235507344
Name:SMYTH-DENT, KELLY LYNN
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:LYNN
Last Name:SMYTH-DENT
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KELLY
Other - Middle Name:SMYTH
Other - Last Name:DENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1177 RACE ST
Mailing Address - Street 2:APT 1005
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-2813
Mailing Address - Country:US
Mailing Address - Phone:336-337-9864
Mailing Address - Fax:
Practice Address - Street 1:1177 RACE ST
Practice Address - Street 2:APT 1005
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-2813
Practice Address - Country:US
Practice Address - Phone:336-337-9864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-04
Last Update Date:2015-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.01053031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical