Provider Demographics
NPI:1588402317
Name:SMITH, KATHLEEN CARMEN
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:CARMEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:CARMEN
Other - Last Name:BURDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5834 BRENTWOOD TRCE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4653
Mailing Address - Country:US
Mailing Address - Phone:360-961-0441
Mailing Address - Fax:
Practice Address - Street 1:1916 PATTERSON ST STE 700
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2177
Practice Address - Country:US
Practice Address - Phone:615-593-3999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist