1730710088 NPI number — MRS. MICHELE DIANE SMITH M.A. LMHC

Table of content: MRS. MICHELE DIANE SMITH M.A. LMHC (NPI 1730710088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730710088 NPI number — MRS. MICHELE DIANE SMITH M.A. LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
MICHELE
Provider Middle Name:
DIANE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A. LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CRANDELL
Provider Other First Name:
MICHELE
Provider Other Middle Name:
DIANE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A. RMHCI
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730710088
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1575 INDIAN RIVER BLVD
Provider Second Line Business Mailing Address:
C110
Provider Business Mailing Address City Name:
VERO BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-888-0212
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1575 INDIAN RIVER BLVD
Provider Second Line Business Practice Location Address:
C110
Provider Business Practice Location Address City Name:
VERO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-888-0212
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/27/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: MH25067 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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