Kenneth Ray Smith, Jr., M.DIV., M.A.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LF00001684 Issued in WA

Practice address

2012 NE 65TH St
Seattle, WA 98115-6934

Phone

(206) 523-3202

Fax

(206) 367-0919

NPI assigned

Nov 29, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mr. Kenneth R. Smith, M.Div., M.a. Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786233600000",
    "number": "1710054028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2012 NE 65TH ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981156934",
            "telephone_number": "206-523-3202",
            "fax_number": "206-367-0919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2012 NE 65TH ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981156934",
            "telephone_number": "206-523-3202",
            "fax_number": "206-367-0919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH, JR.",
        "first_name": "KENNETH",
        "middle_name": "RAY",
        "name_prefix": "Mr.",
        "credential": "M.DIV., M.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-29",
        "last_updated": "2026-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "LF00001684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KENNETH",
            "last_name": "SMITH, M.DIV., M.A.",
            "middle_name": "R.",
            "prefix": "MR.",
            "credential": "M.DIV., M.A.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Jessica Katherine Smith
• Jessy Smith, MSW
• Jocelyn Smith
• Jodi M Smith
• Jody Beth Smith, AU.D. CCC-A
• Justin P Smith, MD
• Kaleen Smith
• Karen Louise Smith, LPTA
• Kassidy Arin Smith, PA-C
• Katherine Marie Smith, D.P.T.

• Mental Health Counselor in Seattle, WA
• Providers in Seattle, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2026; 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.