Provider Demographics
NPI:1811594625
Name:SMITH, KATHLEEN AMELIA (LMHCA)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:AMELIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2367
Mailing Address - Country:US
Mailing Address - Phone:317-236-1500
Mailing Address - Fax:317-261-3375
Practice Address - Street 1:1400 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2305
Practice Address - Country:US
Practice Address - Phone:317-236-1500
Practice Address - Fax:317-261-3375
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
88001054A101YM0800X
IN88001054A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health