Provider Demographics
NPI:1770370017
Name:SMITH, AMANDA LYNN (MA, MLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:
Credentials:MA, MLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1294 W BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-5520
Mailing Address - Country:US
Mailing Address - Phone:810-516-2835
Mailing Address - Fax:
Practice Address - Street 1:1294 W BRISTOL RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-5520
Practice Address - Country:US
Practice Address - Phone:810-243-2990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361000700103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty