Provider Demographics
NPI:1104684117
Name:SMITH, SKYY
Entity type:Individual
Prefix:
First Name:SKYY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S WASHINGTON AVE STE 30
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48607-1217
Mailing Address - Country:US
Mailing Address - Phone:989-209-3247
Mailing Address - Fax:989-209-3246
Practice Address - Street 1:203 S WASHINGTON AVE STE 30
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48607-1217
Practice Address - Country:US
Practice Address - Phone:989-225-7101
Practice Address - Fax:989-209-3246
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician