Individual
ETHAN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
420 S LANDMARK AVE, BLOOMINGTON, IN 47403-5000
(812) 369-4333
Mailing address
420 S LANDMARK AVE, BLOOMINGTON, IN 47403-5000
(812) 369-4333
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39003923A
IN
Other
Enumeration date
04/21/2021
Last updated
07/29/2022
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