Provider Demographics
NPI:1497142186
Name:SMITH, KIMBERLY (LPCC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 HIGHWAY 15 S STE 200
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339-0714
Mailing Address - Country:US
Mailing Address - Phone:606-666-5696
Mailing Address - Fax:606-666-8414
Practice Address - Street 1:1550 HIGHWAY 15 S STE 200
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339-0714
Practice Address - Country:US
Practice Address - Phone:606-666-5696
Practice Address - Fax:606-666-8414
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY260604101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor