Healthcare Provider Details

I. General information

NPI: 1023975679
Provider Name (Legal Business Name): SYDNEY HASTINGS-SMITH MSED
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W DODDS ST
BLOOMINGTON IN
47403-2510
US

IV. Provider business mailing address

2215 S CURRY PIKE
BLOOMINGTON IN
47403-3170
US

V. Phone/Fax

Practice location:
  • Phone: 812-669-2227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number99132558A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: