Provider Demographics
NPI:1396913778
Name:SMITH, KENNETH EUGENE III (LPC, MAC)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:EUGENE
Last Name:SMITH
Suffix:III
Gender:M
Credentials:LPC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5736 MANCHESTER HWY
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:TN
Mailing Address - Zip Code:37357-7503
Mailing Address - Country:US
Mailing Address - Phone:931-815-3871
Mailing Address - Fax:931-815-3876
Practice Address - Street 1:5736 MANCHESTER HWY
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:TN
Practice Address - Zip Code:37357
Practice Address - Country:US
Practice Address - Phone:931-815-3871
Practice Address - Fax:931-815-3876
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
TNLPC0000003229101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)