Healthcare Provider Details

I. General information

NPI: 1922301936
Provider Name (Legal Business Name): KRISTIN MICHELLE SMAHA MA, LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2010
Last Update Date: 01/14/2013
Certification Date: SMAHA KRISTIN MICHELLE 13101 ALLEN RD SOUTHGATE MI 48195 13101 ALLEN RD SOUTHGATE MI 48195
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13101 ALLEN RD
SOUTHGATE MI
48195-2216
US

IV. Provider business mailing address

13101 ALLEN RD
SOUTHGATE MI
48195-2216
US

V. Phone/Fax

Practice location:
  • Phone: 734-785-7704
  • Fax:
Mailing address:
  • Phone: 734-785-7704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health
License Number6401012173
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: