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Individual

CHRIS SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MDIV LMFT

Contact information

Practice address
121 W MAIN ST, PORT WASHINGTON, WI 53074-0994
(262) 284-8200
(262) 284-8104
Mailing address
121 W MAIN ST, PORT WASHINGTON, WI 53074-0994
(262) 284-8200
(262) 284-8104

Taxonomy

Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
68124
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
40981600
WI
Enumeration date
05/07/2008
Last updated
05/07/2008
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