MEDICARE: MRS. AISHA-AMINA SMILEY MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1013309681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AISHA-AMINA SMILEY MSW

Provider Business Mailing Address
First Line	:	240 N TILLOTSON AVE
Second Line	:
City	:	MUNCIE
State	:	IN
Zip	:	47304-3988
Country	:	US
Telephone Number	:	765-288-1928
Fax Number	:	765-741-0335

Provider Business Practice Location Address
First Line	:	1625 MAGNAVOX WAY STE A
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-1586
Country	:	US
Telephone Number	:	260-437-9062
Fax Number	:	260-436-1185

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2015
Last Update Date	:	03/26/2015

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