Provider Demographics
NPI:1245862556
Name:SMELLER, MICHELLE (MFT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SMELLER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7928 SKYLAKE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-3041
Mailing Address - Country:US
Mailing Address - Phone:817-881-7522
Mailing Address - Fax:
Practice Address - Street 1:3900 MERRETT DR STE C
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-2920
Practice Address - Country:US
Practice Address - Phone:817-881-7522
Practice Address - Fax:817-754-5769
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-05
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203690106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist