Provider Demographics
NPI:1619069390
Name:SMITH, WENDY (PHD,LP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD,LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 S TELEGRAPH RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0166
Mailing Address - Country:US
Mailing Address - Phone:248-451-9085
Mailing Address - Fax:248-451-9089
Practice Address - Street 1:1750 S TELEGRAPH RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0166
Practice Address - Country:US
Practice Address - Phone:248-451-9085
Practice Address - Fax:248-451-9089
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI010204103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical