Provider Demographics
NPI:1033473699
Name:SMITH, JULIE CARMEN
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:CARMEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 SAPPHIRE CT
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-8889
Mailing Address - Country:US
Mailing Address - Phone:502-827-9736
Mailing Address - Fax:502-827-9736
Practice Address - Street 1:118 SAPPHIRE CT
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-8889
Practice Address - Country:US
Practice Address - Phone:502-827-9736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YP2500X
KY269018101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100743900Medicaid
KY269018OtherKY LICENSE LPCC