Provider Demographics
NPI:1053691931
Name:SMITH, MAUREEN ANN (LPC)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:MAUREEN
Other - Middle Name:ANN
Other - Last Name:MCKAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:6549 TOWN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-4824
Mailing Address - Country:US
Mailing Address - Phone:248-620-6400
Mailing Address - Fax:248-620-6405
Practice Address - Street 1:42669 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-5036
Practice Address - Country:US
Practice Address - Phone:586-412-5321
Practice Address - Fax:586-412-5327
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010555101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI750910402OtherBLUE CROSS