Provider Demographics
NPI:1477992220
Name:SMITH, SUSAN KYLE (LPCC, LCADC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KYLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPCC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 VEACH RD STE 208
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-6299
Mailing Address - Country:US
Mailing Address - Phone:270-228-0340
Mailing Address - Fax:270-228-0341
Practice Address - Street 1:2816 VEACH RD STE 208
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-6299
Practice Address - Country:US
Practice Address - Phone:270-228-0340
Practice Address - Fax:270-228-0341
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY119300101YA0400X
KY127368101YM0800X
KY246343101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health