Provider Demographics
NPI:1558158758
Name:SMITH, FAYE CORINNE
Entity type:Individual
Prefix:
First Name:FAYE
Middle Name:CORINNE
Last Name:SMITH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6904 SOUTHWIND ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-7769
Mailing Address - Country:US
Mailing Address - Phone:269-355-4264
Mailing Address - Fax:
Practice Address - Street 1:8135 COXS DR STE 110
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-5898
Practice Address - Country:US
Practice Address - Phone:269-360-0865
Practice Address - Fax:269-210-2543
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician