Provider Demographics
NPI:1477933240
Name:SMITH, MICHELLE R (LIMHP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:SMITH
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 N SAUNDERS AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-3813
Mailing Address - Country:US
Mailing Address - Phone:402-460-8670
Mailing Address - Fax:
Practice Address - Street 1:208 S BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-5904
Practice Address - Country:US
Practice Address - Phone:402-705-2364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1201101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100264589-00Medicaid