Kristina P Smith

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

13563 Issued in CA

Practice address

280 17TH St
Oakland, CA 94612-4124

Phone

(510) 514-5948

NPI assigned

May 12, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Professional Psychology Associates, PC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Denver, CO
  • NPI 1316368996
  NPD

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

{
    "created_epoch": "1589241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700784000000",
    "number": "1033731112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 E 58TH AVE STE 210",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802161400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 17TH ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946124124",
            "telephone_number": "510-514-5948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KRISTINA",
        "middle_name": "P",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-12",
        "last_updated": "2023-11-24",
        "certification_date": "2023-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "CO",
            "license": "NLC.0108014",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CA",
            "license": "13563",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA BOARD OF BEHAVIORAL SCIENCES",
            "identifier": "13563",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF REGULATORY AGENCY",
            "identifier": "NLC.0108014",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kpsmith@telecarecorp.com",
            "affiliation": "N",
            "endpointDescription": "EMAIL",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "280 17th St",
            "city": "Oakland",
            "state": "CA",
            "country_code": "US",
            "postal_code": "946124124",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jannett Marie Smith
• Kaci Smith, M.A.
• Kerianna L Smith, ABA
• Kimberly Denise Smith
• Kimberly H Smith, B.A. TEACHER
• Krystal Marie Smith
• L. Aaron Smith
• Lakenya T Smith
• Lashanda Monique Smith
• Latanae Marie Smith

• Professional Counselor in Oakland, CA
• Providers in Oakland, CA by specialty
• Professional Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.