Provider Demographics
NPI:1073777629
Name:SMITH, COLEEN HAAS (MAPC)
Entity Type:Individual
Prefix:MS
First Name:COLEEN
Middle Name:HAAS
Last Name:SMITH
Suffix:
Gender:F
Credentials:MAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 W HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-3252
Mailing Address - Country:US
Mailing Address - Phone:414-345-4941
Mailing Address - Fax:414-342-5326
Practice Address - Street 1:3200 W HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-3252
Practice Address - Country:US
Practice Address - Phone:414-345-4941
Practice Address - Fax:414-342-5326
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI99 228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist