Provider Demographics
NPI:1023870201
Name:SMITH, KARISA M (MA, LPC)
Entity type:Individual
Prefix:
First Name:KARISA
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 S DAWCAMRY LN
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-1759
Mailing Address - Country:US
Mailing Address - Phone:208-204-1189
Mailing Address - Fax:
Practice Address - Street 1:1820 S EAGLE RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2447
Practice Address - Country:US
Practice Address - Phone:208-203-3269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID10146101Y00000X
IDLPC-10146101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor