Individual
JOHN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA LPC CRC SCL
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
00014088
MI
101YP2500X
Professional Counselor
Primary
6401005523
MI
101YS0200X
School Counselor
MI-SC0000000749838
MI
Other
Enumeration date
10/30/2014
Last updated
09/20/2018
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