Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003121765 |
---|---|
Provider Name | Melissa Beth Smart |
First Address | Pueblo, CO 81001-1851 |
Second Address | Pueblo, CO 81004-1128 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2010 |
Last Update Date | 18/08/2010 |