Healthcare Provider Details

I. General information

NPI: 1457842098
Provider Name (Legal Business Name): AMBER MICHELE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SPRING ST
FRIDAY HARBOR WA
98250
US

IV. Provider business mailing address

18 SUNRISE RIDGE RD
FRIDAY HARBOR WA
98250-6949
US

V. Phone/Fax

Practice location:
  • Phone: 360-378-2669
  • Fax:
Mailing address:
  • Phone: 303-946-6267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: