MEDICARE: MS. JULAINE SMITH

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	122781522513	ND
2	101YP2500X	Professional Counselor	1383	WY

General Provider Information

NPI Number	:	1023553088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JULAINE SMITH

Provider Business Mailing Address
First Line	:	104 MAIN ST
Second Line	:
City	:	TURTLE LAKE
State	:	ND
Zip	:	58575-4001
Country	:	US
Telephone Number	:	701-448-2054
Fax Number	:

Provider Business Practice Location Address
First Line	:	416 KUNDERT ST
Second Line	:
City	:	TURTLE LAKE
State	:	ND
Zip	:	58575-4205
Country	:	US
Telephone Number	:	701-448-9225
Fax Number	:

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

Provider Enumeration Date	:	12/30/2016
Last Update Date	:	05/15/2023

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