Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 101YM0800X | Mental Health Counselor | 39002199A | IN |
NPI | 1003066234 |
---|---|
Provider Name | David Smith |
First Address | Muncie, IN 47305-1734 |
Second Address | Muncie, IN 47304-2264 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2008 |
Last Update Date | 17/07/2020 |