Individual provider Active NPI

Kimberlee J Smith Chiago, LPC

  • Professional Counselor
  • Surprise, AZ
National Provider Identifier
1386480960
Registry record updated Oct 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC-23186 Issued in AZ
Practice address
15411 W Waddell Rd
Ste 102 PMB 1211
Surprise, AZ 85379-5170
Phone
(623) 239-3939
Fax
(480) 542-2239
NPI assigned
Jul 3, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 23, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X LPC-23186 AZ Primary

Addresses

Primary practice location

15411 W Waddell Rd
Ste 102 PMB 1211
Surprise, AZ 85379-5170

Mailing address

15411 W Waddell Rd
Ste 102 PMB 1211
Surprise, AZ 85379-5170
Phone (623) 239-3939

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250312002820 AZ Practitioner - Mental Health Counselor 5294256715 Reassigns benefits to 2 organizations
Practice locations: El Mirage, AZ

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

El Mirage, AZ 85335
Phone (623) 239-3939

11542 W Corrine Dr
El Mirage, AZ 85335-3948

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LPC-23186AZMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
People Empowering People of Az Inc. CurrentSince Jul 1, 2024 Accepting new patients
Grow Healthcare Group PA Professional CurrentSince Aug 26, 2025 Accepting new patients
Desert Lakes Counseling LLC Professional CurrentSince May 18, 2025 Accepting new patients
Mental Health Specialty Group PA Professional CurrentSince Mar 5, 2025 Accepting new patients

Locations

2066 W Apache Trl
Ste 101
Apache Junction, AZ 85120
Phone (480) 503-8530

4600 E Washington St
Ste 300
Phoenix, AZ 85034
Phone (602) 638-1872

2550 W Union Hills Dr
Phoenix, AZ 85027
Phone (602) 358-0224

15411 W Waddell Rd
Ste 102
Surprise, AZ 85379
Phone (325) 433-8485

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1719964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761177600000",
    "number": "1386480960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15411 W WADDELL RD",
            "address_2": "STE 102 PMB 1211",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853795170",
            "telephone_number": "623-239-3939",
            "fax_number": "480-542-2239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15411 W WADDELL RD",
            "address_2": "STE 102 PMB 1211",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853795170",
            "telephone_number": "623-239-3939",
            "fax_number": "480-542-2239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH CHIAGO",
        "first_name": "KIMBERLEE",
        "middle_name": "J",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-03",
        "last_updated": "2025-10-23",
        "certification_date": "2025-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AZ",
            "license": "LPC-23186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Surprise, AZ

Sources for this page

Verify at the official NPI Registry.