Provider Demographics
NPI:1386518710
Name:SMITH, TIMOTHY WILLIAM (LPCA)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:WILLIAM
Last Name:SMITH
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8554 KY 1232
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-6417
Mailing Address - Country:US
Mailing Address - Phone:606-261-7622
Mailing Address - Fax:606-261-7312
Practice Address - Street 1:8554 KY 1232
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-6417
Practice Address - Country:US
Practice Address - Phone:606-261-7622
Practice Address - Fax:606-261-7312
Is Sole Proprietor?:No
Enumeration Date:2025-09-30
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY297810101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional