| Doctor Name: | KELLI LEA SMITH |
| NPI Number: | 1043485337 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS |
| License Number: | 00982 |
| Business Practice Address: | 300 W Broadway Suite #107 Council Bluffs, IA - 515039045 |
| Business Phone Number: | 7123283700 |
| Business Fax Number: | 7123283721 |
| Mailing Address: | 300 W Broadway, Suite #107 COUNCIL BLUFFS |
| State: | IA |
| Postal Code: | 515039045 |
| Phone Number: | 7123283700 |
| Fax Number: | 7123283721 |
| NPI Enumeration Date: | 04/28/2008 |
| NPI Last Update Date: | 04/28/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 00982 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |