Provider Demographics
NPI:1336651066
Name:SMITH, EMMA (LLPC)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3639 CASS RD
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-9153
Mailing Address - Country:US
Mailing Address - Phone:231-360-3267
Mailing Address - Fax:
Practice Address - Street 1:3639 CASS RD
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-9153
Practice Address - Country:US
Practice Address - Phone:231-360-3267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-03
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL52572374700000X
MI101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No374700000XNursing Service Related ProvidersTechnician