Provider Demographics
NPI:1831489541
Name:SMITH, ERIN (PHD, LP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 W WACKERLY ST
Mailing Address - Street 2:STE 11
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2769
Mailing Address - Country:US
Mailing Address - Phone:989-832-2165
Mailing Address - Fax:
Practice Address - Street 1:720 W WACKERLY ST
Practice Address - Street 2:SUITE 4
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2769
Practice Address - Country:US
Practice Address - Phone:989-832-2165
Practice Address - Fax:989-839-4376
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2019302103TC0700X
MI6301015898103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical