Healthcare Provider Details

I. General information

NPI: 1114753308
Provider Name (Legal Business Name): JASMINE SMITH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W SAINT JOSEPH ST STE 10
LANSING MI
48933-2265
US

IV. Provider business mailing address

812 E JOLLY RD
LANSING MI
48910-6825
US

V. Phone/Fax

Practice location:
  • Phone: 517-237-7350
  • Fax: 517-346-8291
Mailing address:
  • Phone: 517-237-7350
  • Fax: 517-346-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801109336
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: