Provider Demographics
NPI:1609912807
Name:SMITH, MICHAEL BILL (LMSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BILL
Last Name:SMITH
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 HARRISON PL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-3036
Mailing Address - Country:US
Mailing Address - Phone:785-749-5376
Mailing Address - Fax:
Practice Address - Street 1:2415 MASSACHUSETTS ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-4827
Practice Address - Country:US
Practice Address - Phone:785-832-4802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3643104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker