Provider Demographics
NPI:1780836734
Name:SMITH LAMBE TWO HEADS
Entity type:Organization
Organization Name:SMITH LAMBE TWO HEADS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERV
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAGLIONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-414-0754
Mailing Address - Street 1:29700 HARPER AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082-2601
Mailing Address - Country:US
Mailing Address - Phone:810-622-7805
Mailing Address - Fax:
Practice Address - Street 1:29700 HARPER AVE
Practice Address - Street 2:STE 1
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082-2601
Practice Address - Country:US
Practice Address - Phone:810-622-7805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301053454103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty