Provider Demographics
NPI:1962719526
Name:SMELLIE, SUSAN JOY (LMHC, ATR)
Entity type:Individual
Prefix:
First Name:SUSAN JOY
Middle Name:
Last Name:SMELLIE
Suffix:
Gender:F
Credentials:LMHC, ATR
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:RUTH
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5633 STRAND BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-7300
Mailing Address - Country:US
Mailing Address - Phone:239-596-4278
Mailing Address - Fax:239-593-7746
Practice Address - Street 1:5633 STRAND BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-7300
Practice Address - Country:US
Practice Address - Phone:239-596-4278
Practice Address - Fax:239-593-7746
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9296101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional