Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 6401017436 | MI |
N | 103TC1900X | Counseling Psychologist | 6301012549 |
NPI | 1073014916 |
---|---|
Provider Name | Mindie Adele Smith |
First Address | Kalamazoo, MI 49007-2557 |
Second Address | Kalamazoo, MI 49007-2557 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2018 |
Last Update Date | 24/02/2021 |