Provider Demographics
NPI:1649404880
Name:SMITH, MICHELLE (MS, LMHC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 NE 7TH AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-4542
Mailing Address - Country:US
Mailing Address - Phone:360-574-9595
Mailing Address - Fax:360-574-9685
Practice Address - Street 1:10000 NE 7TH AVE STE 215
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-4542
Practice Address - Country:US
Practice Address - Phone:360-574-9595
Practice Address - Fax:360-574-9685
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC3177OtherLICENSED PROFESSIONAL COUNSELOR
WALH60238411OtherLICENSED MENTAL HEALTH COUNSELOR