Provider Demographics
NPI:1629185681
Name:SMITH, RYAN (LMSW, CADC-M)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:LMSW, CADC-M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 WHIPPLE ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3372
Mailing Address - Country:US
Mailing Address - Phone:810-956-7522
Mailing Address - Fax:
Practice Address - Street 1:1800 IMLAY CITY RD
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-3208
Practice Address - Country:US
Practice Address - Phone:810-245-5704
Practice Address - Fax:810-245-5676
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)