MEDICARE: DR. HAROLD B SMITH PYS.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	6301010743	MI
2	103T00000X	Psychologist	20041353A	IN
3	103T00000X	Psychologist		IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ON12920	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003881533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAROLD B SMITH PYS.D.

Provider Business Mailing Address
First Line	:	9067 US 31
Second Line	:	SUITE 203
City	:	BERRIEN SPRINGS
State	:	MI
Zip	:	49103
Country	:	US
Telephone Number	:	269-471-9892
Fax Number	:

Provider Business Practice Location Address
First Line	:	9067 US HIGHWAY 31
Second Line	:
City	:	BERRIEN SPRINGS
State	:	MI
Zip	:	49103-1664
Country	:	US
Telephone Number	:	269-277-0549
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2006
Last Update Date	:	02/08/2010

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Directions to “ DR. HAROLD B SMITH PYS.D.” Practice Location

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