Provider Demographics
NPI:1144954025
Name:SMITH, KARLEE NICOLE (LMHCA)
Entity type:Individual
Prefix:
First Name:KARLEE
Middle Name:NICOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 UNICK RD
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-9021
Mailing Address - Country:US
Mailing Address - Phone:360-393-2830
Mailing Address - Fax:
Practice Address - Street 1:3111 UNICK RD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-9021
Practice Address - Country:US
Practice Address - Phone:360-393-2830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61321857101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMC61321857OtherMENTAL HEALTH COUNSELOR ASSOCIATE LICENSE