MEDICARE: ALAINA SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6401013297	MI

General Provider Information

NPI Number	:	1467845016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAINA SMITH

Provider Business Mailing Address
First Line	:	1345 MONROE AVE NW STE 323
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-4674
Country	:	US
Telephone Number	:	616-284-1329
Fax Number	:

Provider Business Practice Location Address
First Line	:	1345 MONROE AVE NW STE 323
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-4674
Country	:	US
Telephone Number	:	616-284-1329
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2015
Last Update Date	:	04/29/2024

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