MEDICARE: MICHELLE MARIE 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	101YM0800X	Mental Health Counselor
2	172V00000X	Community Health Worker		NV

General Provider Information

NPI Number	:	1689976821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE MARIE SMITH

Provider Business Mailing Address
First Line	:	2101 HUSSIUM HILLS ST
Second Line	:	UNIT #105
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-6700
Country	:	US
Telephone Number	:	702-624-8166
Fax Number	:

Provider Business Practice Location Address
First Line	:	2101 HUSSIUM HILLS ST
Second Line	:	UNIT #105
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-6700
Country	:	US
Telephone Number	:	702-624-8166
Fax Number	:

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

Provider Enumeration Date	:	11/19/2010
Last Update Date	:	02/12/2026

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Directions to “ MICHELLE MARIE SMITH ” Practice Location

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