Provider Demographics
NPI:1477298768
Name:SMITH, MICHAEL F (LPC, MS, MA, MBA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:SMITH
Suffix:
Gender:M
Credentials:LPC, MS, MA, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5699 N CENTERPARK WAY APT 544
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4576
Mailing Address - Country:US
Mailing Address - Phone:414-721-1911
Mailing Address - Fax:
Practice Address - Street 1:5699 N CENTERPARK WAY APT 544
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-4576
Practice Address - Country:US
Practice Address - Phone:414-415-0999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-01
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11022-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional