Provider Demographics
NPI:1821519232
Name:SMILEY, JIMMARIE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JIMMARIE
Middle Name:
Last Name:SMILEY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 E CEDAR ST STE 106
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1886
Mailing Address - Country:US
Mailing Address - Phone:913-214-2022
Mailing Address - Fax:
Practice Address - Street 1:1707 E CEDAR ST STE 106
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1886
Practice Address - Country:US
Practice Address - Phone:913-214-2022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018009415101YP2500X
KS3190101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSB201197870Medicaid