Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | MT1828 | FL |
NPI | 1275124109 |
---|---|
Provider Name | Dr. Kenneth Lee Smylie |
First Address | Gainesville, FL 32653-0078 |
Second Address | Gainesville, FL 32653-0078 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2021 |
Last Update Date | 02/02/2021 |