Kyle James Smyth, LPCC, LADC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

4377 Issued in MN

Practice address

7766 Highway 65 NE
Spring Lake Park, MN 55432-2832

Phone

(763) 205-4843

Fax

(612) 416-2085

NPI assigned

Dec 28, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Expanse - a Minnesota Mental Health Ketamine & Psychedelic Psychother

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Minneapolis, MN
  • NPI 1528726775
  NPD (past)

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

{
    "created_epoch": "1545955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721779200000",
    "number": "1568934776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 4TH ST E APT 1122",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551012524",
            "telephone_number": "651-207-9860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7766 HIGHWAY 65 NE",
            "city": "SPRING LAKE PARK",
            "state": "MN",
            "postal_code": "554322832",
            "telephone_number": "763-205-4843",
            "fax_number": "612-416-2085"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6636 Cedar Ave S Ste 380",
            "address_purpose": "LOCATION",
            "city": "Richfield",
            "state": "MN",
            "postal_code": "554232712",
            "country_code": "US",
            "telephone_number": "612-758-0893",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1935 County Road B2 W Ste 240",
            "address_purpose": "LOCATION",
            "city": "Roseville",
            "state": "MN",
            "postal_code": "551132722",
            "country_code": "US",
            "telephone_number": "763-600-7572",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMYTH",
        "first_name": "KYLE",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "credential": "LPCC, LADC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-12-28",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "305110",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "4377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Spring Lake Park, MN
• Providers in Spring Lake Park, MN by specialty
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2024; 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.