Provider Demographics
NPI:1538866835
Name:SMITH, BREEA (MA, LPCA)
Entity type:Individual
Prefix:
First Name:BREEA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 APPIAN CROSSING WAY APT 708
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-1052
Mailing Address - Country:US
Mailing Address - Phone:859-327-5984
Mailing Address - Fax:
Practice Address - Street 1:2250 THUNDERSTICK DR STE 1104
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-9009
Practice Address - Country:US
Practice Address - Phone:859-327-5984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY281830101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health