MEDICARE: ADAM SMITH

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1386761070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM SMITH

Provider Business Mailing Address
First Line	:	604 E 3RD ST
Second Line	:
City	:	DIXON
State	:	IL
Zip	:	61021-3210
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 S 4TH ST
Second Line	:
City	:	OREGON
State	:	IL
Zip	:	61061-1609
Country	:	US
Telephone Number	:	815-732-3157
Fax Number	:

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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Directions to “ ADAM SMITH ” Practice Location

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