Provider Demographics
NPI:1053659805
Name:SMITH, BETTY ANN (MA, LLPC)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:ANN
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1375 R DALE WERTZ DR
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-1365
Mailing Address - Country:US
Mailing Address - Phone:989-269-9293
Mailing Address - Fax:
Practice Address - Street 1:1375 R DALE WERTZ DR
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-1365
Practice Address - Country:US
Practice Address - Phone:989-269-9293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013028101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional