Individual
SHERRY SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5383 GREAT WOODS DR, INDIANAPOLIS, IN 46224-6196
(317) 985-1485
Mailing address
5383 GREAT WOODS DR, INDIANAPOLIS, IN 46224-6196
(317) 985-1485
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201057290 A
MEDICAID LEGACY PROVIDER ID
IN
Enumeration date
07/02/2014
Last updated
07/02/2014
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