Basic Information
| Provider Information | |||||||||
| NPI: | 1346469491 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.ED, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3806 BROTHERTON RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452091504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137521555 | ||||||||
| FaxNumber: | 5136888155 | ||||||||
| Practice Location | |||||||||
| Address1: | 551 BATAVIA PIKE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452441518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137521555 | ||||||||
| FaxNumber: | 5136888155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | C8309 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | C8309 | 01 | OH | PROFESSIONAL COUNSELOR | OTHER |