Individual
MARVIN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
761 E UNIVERSITY DR, MESA, AZ 85203-7961
(678) 953-6713
Mailing address
761 E UNIVERSITY DR, MESA, AZ 85203-7961
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TP0016X
Prescribing (Medical) Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
104100000X
Social Worker
—
—
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
04/20/2022
Last updated
04/20/2022
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