Doctor Name: | AMANDA SMITH |
NPI Number: | 1174987200 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 8311 Roosevelt Rd Forest Park, IL - 601302529 |
Business Phone Number: | 7082092291 |
Business Fax Number: | |
Mailing Address: | 8311 Roosevelt Rd, FOREST PARK |
State: | IL |
Postal Code: | 601302529 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 04/05/2016 |
NPI Last Update Date: | 04/05/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |