Provider Demographics
NPI:1114699188
Name:AMIE SMITH COUNSELING PLLC
Entity Type:Organization
Organization Name:AMIE SMITH COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:309-613-3173
Mailing Address - Street 1:409 S HARRIS ST
Mailing Address - Street 2:
Mailing Address - City:TREMONT
Mailing Address - State:IL
Mailing Address - Zip Code:61568-8143
Mailing Address - Country:US
Mailing Address - Phone:309-613-3173
Mailing Address - Fax:
Practice Address - Street 1:1100 BEECH ST
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-1493
Practice Address - Country:US
Practice Address - Phone:309-613-3173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty