Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 6301007589 | MI |
Y | 103T00000X | Psychologist | 6301007589 | MI |
N | 103TA0700X | Adult Development & Aging Psychologist | 6301007589 | MI |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 6301007589 | MI |
N | 103G00000X | Clinical Psychologist | 6301007589 | MI |
N | 103TC0700X | Clinical Psychologist | 6301007589 | MI |
N | 103TC1900X | Counseling Psychologist | 6301007589 | MI |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 6301007589 | MI |
N | 103TF0000X | Family Psychologist | 6301007589 | MI |
N | 103TH0004X | Health Psychologist | 6301007589 | MI |
N | 103TH0100X | Health Service | 6301007589 | MI |
N | 103TM1800X | Intellectual & Developmental Disabilities | 6301007589 | MI |
N | 103TP2701X | Group Psychotherapist | 6301007589 | MI |
N | 103TS0200X | School Psychologist | CC-3C4770033286 | MI |
NPI | 1205116639 |
---|---|
Provider Name | Dr. Sherry Ann Smith |
First Address | Royal Oak, MI 48073-0990 |
Second Address | Royal Oak, MI 48073-0990 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2011 |
Last Update Date | 25/08/2017 |