Provider Demographics
NPI:1013228659
Name:SMITHSON, GWEN MICHELLE (MFT INTERN)
Entity Type:Individual
Prefix:MS
First Name:GWEN
Middle Name:MICHELLE
Last Name:SMITHSON
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1179 SCENIC PARK TER
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-5819
Mailing Address - Country:US
Mailing Address - Phone:775-225-4617
Mailing Address - Fax:
Practice Address - Street 1:1179 SCENIC PARK TER
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5819
Practice Address - Country:US
Practice Address - Phone:775-225-4617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01211106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist