Provider Demographics
NPI:1194493098
Name:SMITH, KI NINA ELIZABETH
Entity type:Individual
Prefix:
First Name:KI
Middle Name:NINA ELIZABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:ELIZABETH ANN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7480 MT MEEKER RD
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-2238
Mailing Address - Country:US
Mailing Address - Phone:971-331-9484
Mailing Address - Fax:
Practice Address - Street 1:2500 30TH ST STE 201
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1238
Practice Address - Country:US
Practice Address - Phone:971-331-9484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health