MEDICARE: MR. BYRNE CRAIG SMITH PHD

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	103TC0700X	Clinical Psychologist	6301014029	MI

General Provider Information

NPI Number	:	1124140017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BYRNE CRAIG SMITH PHD

Provider Business Mailing Address
First Line	:	PO BOX 2257
Second Line	:
City	:	CHESTERTON
State	:	IN
Zip	:	46304-0357
Country	:	US
Telephone Number	:	219-926-8320
Fax Number	:	219-926-3524

Provider Business Practice Location Address
First Line	:	1905 ABBOT RD STE 1
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-8571
Country	:	US
Telephone Number	:	517-282-8249
Fax Number	:	517-253-7119

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

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	11/24/2015

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