| Doctor Name: | MR. KENNETH JAY SMOTHERS |
| NPI Number: | 1114288461 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M. ED., L.P.C. |
| License Number: | 10616 |
| Business Practice Address: | 330 Main St Suite 7 Sealy, TX - 774742391 |
| Business Phone Number: | 9798852900 |
| Business Fax Number: | |
| Mailing Address: | 123 Creek Bend Ln, COLUMBUS |
| State: | TX |
| Postal Code: | 789342052 |
| Phone Number: | 9798852900 |
| Fax Number: | |
| NPI Enumeration Date: | 06/04/2012 |
| NPI Last Update Date: | 06/04/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 10616 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |