Provider Demographics
NPI:1386523785
Name:K DAVID SMITH COACHING LLC
Entity type:Organization
Organization Name:K DAVID SMITH COACHING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-291-1377
Mailing Address - Street 1:524 NW WOODSON DR
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1174
Mailing Address - Country:US
Mailing Address - Phone:541-291-1377
Mailing Address - Fax:541-205-9431
Practice Address - Street 1:524 NW WOODSON DR
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1174
Practice Address - Country:US
Practice Address - Phone:541-291-1377
Practice Address - Fax:541-205-9431
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:K DAVID SMITH COACHING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty