Provider Demographics
NPI:1770983348
Name:SMITH, KIM ALMON (MA, CADAC II)
Entity type:Individual
Prefix:MR
First Name:KIM
Middle Name:ALMON
Last Name:SMITH
Suffix:
Gender:M
Credentials:MA, CADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3850
Mailing Address - Country:US
Mailing Address - Phone:765-450-4843
Mailing Address - Fax:
Practice Address - Street 1:315 W LINCOLN RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3850
Practice Address - Country:US
Practice Address - Phone:765-450-4843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor