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NPI Code Detail

MEDICARE: SEAN SMITHAM PHD

MEDICARE: SEAN SMITHAM 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
1103T00000XPsychologistPY00003757WA
2103TC0700XClinical PsychologistPY00003757WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1861546129
Entity Type Code : Individual
Provider Name (Legal Business Name) : SEAN SMITHAM PHD
Provider Business Mailing Address
First Line : PO BOX 112
Second Line :
City : SPOKANE
State : WA
Zip : 99210-0112
Country : US
Telephone Number : 509-464-6208
Fax Number : 888-316-1928
Provider Business Practice Location Address
First Line : 3124 S REGAL ST
Second Line :
City : SPOKANE
State : WA
Zip : 99223-4704
Country : US
Telephone Number : 509-464-6208
Fax Number : 888-316-1928
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2007
Last Update Date : 08/26/2019

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Directions to “ SEAN SMITHAM PHD” Practice Location

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