Provider Demographics
NPI:1871391441
Name:SMITH, MICHAEL LEWIS (LMSW, LMFT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEWIS
Last Name:SMITH
Suffix:
Gender:
Credentials:LMSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 N RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48609-6832
Mailing Address - Country:US
Mailing Address - Phone:989-596-3544
Mailing Address - Fax:
Practice Address - Street 1:24455 CROCKER BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48036-3260
Practice Address - Country:US
Practice Address - Phone:989-596-3544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010572001041C0700X
MI4101005426106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist