Provider Demographics
NPI:1558177691
Name:SMITHMYER, KATELYN
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:SMITHMYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13201 SUGARBLUFF RD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34715-6819
Mailing Address - Country:US
Mailing Address - Phone:352-223-1999
Mailing Address - Fax:
Practice Address - Street 1:350 ACCEPTANCE WAY
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2788
Practice Address - Country:US
Practice Address - Phone:352-223-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician