Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 6301017632 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301017632 | MI |
N | 103TR0400X | Rehabilitation Psychologist | 6301017632 | MI |
NPI | 1588119168 |
---|---|
Provider Name | Evan Lee Smith |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48108-5744 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2016 |
Last Update Date | 10/01/2019 |