Provider Demographics
NPI:1699310698
Name:SMILEY, AUBREY M (MS)
Entity type:Individual
Prefix:MRS
First Name:AUBREY
Middle Name:M
Last Name:SMILEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:AUBREY
Other - Middle Name:M
Other - Last Name:SMILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:120 STEVENS ST SW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-1526
Mailing Address - Country:US
Mailing Address - Phone:517-525-0792
Mailing Address - Fax:
Practice Address - Street 1:341 WARE ST
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-8518
Practice Address - Country:US
Practice Address - Phone:517-525-0792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 106S00000X
MI103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician