Individual
MRS. KIM MARIE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, LMFT
Contact information
Practice address
3266 MALLARD COVE LN, FORT WAYNE, IN 46804-2883
(260) 436-5986
(260) 436-1859
Mailing address
3266 MALLARD COVE LN, FORT WAYNE, IN 46804-2883
(260) 436-5986
(260) 436-1859
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
34002738A
IN
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000200512
ANTHEM BLUE CROSS BLUE SH
IN
01
—
064061000
MAGELLAN
—
01
—
090831
MHN
—
Enumeration date
03/10/2007
Last updated
02/26/2025
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