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General NPI Number Information
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NPI Number | 1922702331
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Entity Type | Organization
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Legal Business Name | VICKI NELSON SMEBY MA LLP LLC
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Dates
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Enumeration Date | 03/29/2023
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Last Update Date | 03/29/2023
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Provider Practice Location Address
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Address Line | 2208 STRATFORD CT SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-4133
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Country | US
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Telephone | 616-460-1819
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Fax |
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Provider Business Mailing Address
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Address Line | 6757 CASCADE RD SE # S-103
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-6849
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Country | US
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Telephone | 616-460-1819
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Fax |
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Authorized Official
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Title or Position | OWNER/ PROVIDER/ PSYCHOLOGIST
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Name | MS. VICKI LYNN NELSON SMEBY
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Credential | MA LLP
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Telephone | 616-460-1819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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