Crystal Lauren Smith, BC-DMT, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180.006725 Issued in IL

Practice address

636 Church St
Suite 510
Evanston, IL 60201-4508

Phone

(773) 817-2797

NPI assigned

Oct 21, 2008

Sex

Female

Sole proprietor

Yes

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

State licenses

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

{
    "created_epoch": "1224547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1417109406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "636 CHURCH ST",
            "address_2": "SUITE 510",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "636 CHURCH ST",
            "address_2": "SUITE 510",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014508",
            "telephone_number": "773-817-2797"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "333 N La Grange Rd",
            "address_purpose": "LOCATION",
            "city": "LA Grange Park",
            "state": "IL",
            "postal_code": "605265646",
            "country_code": "US",
            "telephone_number": "708-698-5090",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "CRYSTAL",
        "middle_name": "LAUREN",
        "credential": "BC-DMT, LCPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-10-21",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.006725",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeremy Smiley
• Jodi Michelle Smith-Cohen, LMFT
• Alexander Smith
• Alexandra Michelle Smith, PA
• Becky Alison Smith, MD
• Gail Susan Smith, MD
• India Smith, LCSW
• Kimberly Mays Smith, DDS
• Kyran D Smith, MD
• Laura Anne Smith

• Professional Counselor in Evanston, IL
• Providers in Evanston, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.