Kimberly Jill Smith, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

67884 Issued in TX

Practice address

620 Stoneglen Dr Ste B
Keller, TX 76248-3625

Phone

(817) 562-8800

NPI assigned

Oct 17, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1697500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697500800000",
    "number": "1023890811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3308 RIVERMOOR CT",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761169562",
            "telephone_number": "254-855-5147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 STONEGLEN DR STE B",
            "city": "KELLER",
            "state": "TX",
            "postal_code": "762483625",
            "telephone_number": "817-562-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KIMBERLY",
        "middle_name": "JILL",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-17",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "67884",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carissa Small
• Adrienne Smith, APRN, WHNP-BC
• Carly Mae Smith, OTR
• Chelsea Michelle Smith
• David Harrison Smith, D.C.
• Samantha Smith
• Shandy Renee Smith, MS CCC-SLP
• Tiffaney Smith, LPC
• Andrea Snow
• Edirin Ursula Sodje

• Professional Counselor in Keller, TX
• Providers in Keller, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.