Healthcare Provider Details

I. General information

NPI: 1013980028
Provider Name (Legal Business Name): CHRISTINA RENEE SMITH LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 E WASHINGTON ST
MUNCIE IN
47305-1734
US

IV. Provider business mailing address

2501 W WOODBRIDGE DR
MUNCIE IN
47304-1064
US

V. Phone/Fax

Practice location:
  • Phone: 765-273-3224
  • Fax:
Mailing address:
  • Phone: 765-273-3224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39001514A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: