Provider Demographics
NPI:1922702331
Name:VICKI NELSON SMEBY MA LLP LLC
Entity Type:Organization
Organization Name:VICKI NELSON SMEBY MA LLP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PROVIDER/ PSYCHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:LYNN NELSON
Authorized Official - Last Name:SMEBY
Authorized Official - Suffix:
Authorized Official - Credentials:MA LLP
Authorized Official - Phone:616-460-1819
Mailing Address - Street 1:6757 CASCADE RD SE # S-103
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6849
Mailing Address - Country:US
Mailing Address - Phone:616-460-1819
Mailing Address - Fax:
Practice Address - Street 1:2208 STRATFORD CT SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-4133
Practice Address - Country:US
Practice Address - Phone:616-460-1819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VICKI NELSON SMEBY MA LLP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty