Individual
MICHELLE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
1728 MAIN ST, FOREST GROVE, OR 97116-2737
(503) 357-6171
Mailing address
1728 MAIN ST, FOREST GROVE, OR 97116-2737
(503) 357-6171
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
3574
OR
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
3574
OR
Other
Enumeration date
06/01/2016
Last updated
10/17/2023
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