Kristy Smith, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180014855 Issued in IL

Practice address

525 E North St
Bradley, IL 60915-1185

Phone

(888) 870-1775

NPI assigned

Aug 5, 2020

Sex

Female

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

Enrolled in IL

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Rodasi LLC

  dba Ardent Center

  • Mental Health Counselor
  • Hoffman Estates, IL
  • NPI 1467691790
  Medicare reassignment NPD

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

{
    "created_epoch": "1596585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678838400000",
    "number": "1598375552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 W ELM ST",
            "city": "WATSEKA",
            "state": "IL",
            "postal_code": "609701228",
            "telephone_number": "815-383-7669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 E NORTH ST",
            "city": "BRADLEY",
            "state": "IL",
            "postal_code": "609151185",
            "telephone_number": "888-870-1775"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "755 Almar Pkwy Ste A",
            "address_purpose": "LOCATION",
            "city": "Bourbonnais",
            "state": "IL",
            "postal_code": "609142393",
            "country_code": "US",
            "telephone_number": "888-428-7890",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KRISTY",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-05",
        "last_updated": "2023-03-15",
        "certification_date": "2023-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180014855",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "178012642",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jalaal Shah, D.O.
• Bakht Siddiqui, MD
• Aileen Sim, RN, APN, FNP-BC
• Stephanie Skowron, LPC
• Milton John Smit, MD
• Elizabeth Sonneveld, LPC
• Mia Steeves
• Alan Stirling
• Zain S Talukdar, MD
• Debra Marie Tamez, LCSW

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.