Kelly Smith

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

1675 SW Marlow Ave Ste 200
Portland, OR 97225-5102

Phone

(866) 523-4268

Fax

(510) 900-4310

NPI assigned

Sep 23, 2020

Sex

Male

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

Medicare enrollment (NPD)

Not enrolled

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.

• Intercare Therapy Inc.

  • Community/Behavioral Health Agency
  • Las Vegas, NV
  • NPI 1164065892
  NPD
• Building Blocks Behavior Consultants

  • Community/Behavioral Health Agency
  • Roseville, CA
  • NPI 1417245218
  NPD (past)

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

{
    "created_epoch": "1600819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698278400000",
    "number": "1356957435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4221 WILSHIRE BLVD STE 300A",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900103537",
            "telephone_number": "323-556-3053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1675 SW MARLOW AVE STE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255102",
            "telephone_number": "866-523-4268",
            "fax_number": "510-900-4310"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "214 Estates Dr Ste A",
            "address_purpose": "LOCATION",
            "city": "Roseville",
            "state": "CA",
            "postal_code": "956782353",
            "country_code": "US",
            "telephone_number": "916-749-4646",
            "fax_number": "323-866-1880",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KELLY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-23",
        "last_updated": "2023-10-26",
        "certification_date": "2023-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn A. Smith, PMHNP
• Kathryn Elizabeth Smith
• Kathryn Ruth Smith, N.D.
• Katie Smith
• Kaylie Aurora Smith, PT,DPT
• Kelly Smith, RDH
• Kelly Smith, MSW
• Kelly Anne Smith, L.M.T.
• Kelsie C Smith, CCC-SLP
• Kevin Smith, PHARMD, RPH

• Behavior Technician in Portland, OR
• Providers in Portland, OR by specialty
• Behavior Technician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 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.