Katherine Smith

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

360 N Sepulveda Blvd
2075
El Segundo, CA 90245-4460

Phone

(310) 414-2090

Fax

(310) 414-2096

NPI assigned

Mar 10, 2011

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

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.

Opted out of Medicare

Yes, effective Jan 22, 2024 through Jan 22, 2028

Medicare enrollment (NPD)

Not enrolled

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.

• South Bay Center for Counseling

  • Community/Behavioral Health Agency
  • Wilmington, CA
  • NPI 1942508320
  NPD (past)

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

{
    "created_epoch": "1299715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305072000000",
    "number": "1689972903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 N SEPULVEDA BLVD",
            "address_2": "2075",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902454460",
            "telephone_number": "310-414-2090",
            "fax_number": "310-414-2096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 N SEPULVEDA BLVD",
            "address_2": "2075",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902454460",
            "telephone_number": "310-414-2090",
            "fax_number": "310-414-2096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KATHERINE",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-03-10",
        "last_updated": "2011-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jada Jelisa Smith
• Jalen Smith
• Jamila Smith
• Jessica Smith, PT, DPT
• Joshua Smith, BCBA
• Kaylah Smith
• Meredith Burneal Smith, PHD CLINICAL PSYCH
• Michelle Smith
• Misty Smith
• Mya Smith

• Mental Health Counselor in El Segundo, CA
• Providers in El Segundo, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2011; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.