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General NPI Number Information
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NPI Number | 1346521135
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Entity Type | Individual
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Provider Name | JAMEEL MONTGOMERY SMITH PH.D., L.P. NCSP
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Gender | Female
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Dates
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Enumeration Date | 09/07/2011
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 400 MACK AVE STE 1
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City | DETROIT
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State | MI
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Zip | 48201-2136
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Country | US
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Telephone | 313-448-9600
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Fax |
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Provider Business Mailing Address
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Address Line | 2799 W GRAND BLVD
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City | DETROIT
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State | MI
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Zip | 48202-2608
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Country | US
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Telephone | 800-653-6568
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301019161
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License Number State | MI
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