Kim Marie Smith, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

5778-125 Issued in WI

Practice address

301 E Saint Joseph St
Green Bay, WI 54301-2241

Phone

(920) 433-6073

Fax

(920) 431-0333

NPI assigned

Aug 31, 2015

Last updated

Oct 14, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Opted out of Medicare

Yes, effective Jan 7, 2024 through Jan 7, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kimsmith@tdh.allscriptsdirect.net

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.

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  NPD (past)

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

{
    "created_epoch": "1440979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571011200000",
    "number": "1972970572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22040",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052040",
            "telephone_number": "920-445-7222",
            "fax_number": "920-445-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 E SAINT JOSEPH ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543012241",
            "telephone_number": "920-433-6073",
            "fax_number": "920-431-0333"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "744 S Webster Ave",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543013505",
            "country_code": "US",
            "telephone_number": "920-433-3500",
            "fax_number": "920-445-7301",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "704 S Webster Ave",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543013528",
            "country_code": "US",
            "telephone_number": "920-433-3630",
            "fax_number": "920-437-0533",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "158 S Anderson St",
            "address_purpose": "LOCATION",
            "city": "Rhinelander",
            "state": "WI",
            "postal_code": "545013447",
            "country_code": "US",
            "telephone_number": "715-369-7300",
            "fax_number": "715-369-7301",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "720 S VanBuren St",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543013534",
            "country_code": "US",
            "telephone_number": "920-433-6073",
            "fax_number": "920-432-6313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KIM",
        "middle_name": "MARIE",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-31",
        "last_updated": "2019-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "5778-125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Darrell Smith
• Elaine M Smith, PA
• Jeffrey Thomas Smith, OTR/L, CHT
• Kelly J Smith, BCBA
• Kelsey Smith, DPT
• Melissa Anne Smith, A.P.N.P.
• Renee R Smith, CNM,APNP
• Richard Tyler Smith, D.D.S.
• Rodney Lawrence Smith, DC
• Roger P Smith

• Professional Counselor in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.