Provider Demographics
NPI:1689976821
Name:SMITH, MICHELLE MARIE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 HUSSIUM HILLS ST
Mailing Address - Street 2:UNIT #105
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-6700
Mailing Address - Country:US
Mailing Address - Phone:702-624-8166
Mailing Address - Fax:
Practice Address - Street 1:2101 HUSSIUM HILLS ST
Practice Address - Street 2:UNIT #105
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-6700
Practice Address - Country:US
Practice Address - Phone:702-624-8166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health