Individual
TYLER CHARLES SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC, CSAC
Contact information
Practice address
7957 W WIND LAKE RD STE E, WATERFORD, WI 53185-2234
(608) 561-8656
Mailing address
7957 W WIND LAKE RD STE E, WATERFORD, WI 53185-2234
(608) 561-8656
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
17132132
WI
101YM0800X
Mental Health Counselor
Primary
10088125
WI
Other
Enumeration date
05/11/2024
Last updated
05/11/2024
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