Active NPI
Tynetta Amber Smith, M.S., DTLLP
- Counseling Psychologist
- Portage, MI
National Provider Identifier
1700313764
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 6352000873
- Practice address
- 1400 W Milham Ave
Portage, MI 49024-1209 - Phone
- (888) 344-5977
- NPI assigned
- May 21, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 6352000873 | MI | Primary |
Addresses
Primary practice location
1400 W Milham Ave
Portage, MI 49024-1209
Mailing address
3426 W Main St Apt 3
Kalamazoo, MI 49006-6035
Phone (410) 903-8439
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6352000873 | MI | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1495324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686614400000",
"number": "1700313764",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3426 W MAIN ST APT 3",
"city": "KALAMAZOO",
"state": "MI",
"postal_code": "490066035",
"telephone_number": "410-903-8439"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 W MILHAM AVE",
"city": "PORTAGE",
"state": "MI",
"postal_code": "490241209",
"telephone_number": "888-344-5977"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "TYNETTA",
"middle_name": "AMBER",
"name_prefix": "Ms.",
"credential": "M.S., DTLLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-05-21",
"last_updated": "2023-06-13",
"certification_date": "2023-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "MI",
"license": "6352000873",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portage, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.