Provider Demographics
NPI:1679750798
Name:SMITH, KANDY M (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KANDY
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:KANDY
Other - Middle Name:MICHELLE
Other - Last Name:CROMWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PLPC
Mailing Address - Street 1:3751 PENNRIDGE DR STE 119
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-1244
Mailing Address - Country:US
Mailing Address - Phone:314-739-4515
Mailing Address - Fax:314-558-1839
Practice Address - Street 1:3751 PENNRIDGE DR STE 119
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-1244
Practice Address - Country:US
Practice Address - Phone:341-739-4515
Practice Address - Fax:314-558-1839
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008026799101YP2500X
MOK035106007101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional