Provider Demographics
NPI:1043234081
Name:SMITH, MAUREEN GAIL (MA, LLPC, CFLE)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:GAIL
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, LLPC, CFLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11050 MAPLE RUN BLVD
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-2401
Mailing Address - Country:US
Mailing Address - Phone:810-820-0036
Mailing Address - Fax:
Practice Address - Street 1:11050 MAPLE RUN BLVD
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-2401
Practice Address - Country:US
Practice Address - Phone:810-820-0036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009079101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional