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NPI Code Detail

MEDICARE: ADAM SMITH

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
1101YM0800XMental 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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