Provider Demographics
NPI:1730128794
Name:SMITH, EVELYN SCHULZ (MSW)
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:SCHULZ
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33045 HAMILTON CT
Mailing Address - Street 2:SUITE W-300
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3385
Mailing Address - Country:US
Mailing Address - Phone:248-848-1558
Mailing Address - Fax:248-848-3592
Practice Address - Street 1:33045 HAMILTON CT
Practice Address - Street 2:SUITE W-300
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3385
Practice Address - Country:US
Practice Address - Phone:248-848-1558
Practice Address - Fax:248-848-3592
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0105091041C0700X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP12140038Medicare ID - Type UnspecifiedINDIVIDUAL ID NUMBER