Provider Demographics
NPI:1205970233
Name:SMITH, KEVIN SCOTT (REGISTERED CERTIFICA)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:SCOTT
Last Name:SMITH
Suffix:
Gender:M
Credentials:REGISTERED CERTIFICA
Other - Prefix:MR
Other - First Name:KEVIN
Other - Middle Name:SCOTT
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1337 W LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-7502
Mailing Address - Country:US
Mailing Address - Phone:805-740-9799
Mailing Address - Fax:805-740-2799
Practice Address - Street 1:1337 W LOCUST STREET
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7502
Practice Address - Country:US
Practice Address - Phone:805-740-9799
Practice Address - Fax:805-740-2799
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-S0511241612101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor