Provider Demographics
NPI:1750978532
Name:SMART, MICHELLE YVETTE (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:YVETTE
Last Name:SMART
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8436 ROANOKE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-4544
Mailing Address - Country:US
Mailing Address - Phone:314-383-8719
Mailing Address - Fax:
Practice Address - Street 1:10235 ASHBROOK DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63137-1522
Practice Address - Country:US
Practice Address - Phone:314-831-1533
Practice Address - Fax:314-831-1391
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0041001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical