Provider Demographics
NPI:1366061350
Name:SMOUS, MADELINE MCGAW (ACIT)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:MCGAW
Last Name:SMOUS
Suffix:
Gender:F
Credentials:ACIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 LINCOLNWAY E
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-3501
Mailing Address - Country:US
Mailing Address - Phone:574-252-7233
Mailing Address - Fax:844-361-2090
Practice Address - Street 1:3006 LINCOLNWAY E
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-3501
Practice Address - Country:US
Practice Address - Phone:574-252-7233
Practice Address - Fax:844-361-2090
Is Sole Proprietor?:No
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INT-5072101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)