Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ||
N | 103TH0004X | Health Psychologist |
NPI | 1457842098 |
---|---|
Provider Name | Amber Michele Smith |
First Address | Friday Harbor, WA 98250-6949 |
Second Address | Friday Harbor, WA 98250 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2018 |
Last Update Date | 18/05/2018 |