Provider Demographics
NPI:1467752964
Name:SMITH, BROOKE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 W. MICHIGAN AVE.
Mailing Address - Street 2:DEPARTMENT OF PSYCHOLOGY
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-5439
Mailing Address - Country:US
Mailing Address - Phone:269-387-4488
Mailing Address - Fax:
Practice Address - Street 1:1903 W. MICHIGAN AVE.
Practice Address - Street 2:DEPARTMENT OF PSYCHOLOGY
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-5439
Practice Address - Country:US
Practice Address - Phone:269-387-4488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-30
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301018899103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical