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General NPI Number Information
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NPI Number | 1871316224
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Entity Type | Individual
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Provider Name | JASON ANDREW SMITH MA TLLP LLPC
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Gender | Male
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Dates
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Enumeration Date | 11/04/2024
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 496 W ANN ARBOR TRL STE 101
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City | PLYMOUTH
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State | MI
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Zip | 48170-6262
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Country | US
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Telephone | 734-347-6562
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Fax |
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Provider Business Mailing Address
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Address Line | 11536 ASPEN DR
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City | PLYMOUTH
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State | MI
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Zip | 48170-4597
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Country | US
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Telephone | 734-347-6562
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6451023628
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6362009926
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License Number State | MI
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