Healthcare Provider Details

I. General information

NPI: 1407106909
Provider Name (Legal Business Name): SMITH GROUP BEHAVIORAL CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 EXECUTIVE PARK DR SUITE A
OPELIKA AL
36801-6074
US

IV. Provider business mailing address

2006 EXECUTIVE PARK DR SUITE A
OPELIKA AL
36801-6074
US

V. Phone/Fax

Practice location:
  • Phone: 334-332-9077
  • Fax: 334-363-0740
Mailing address:
  • Phone: 334-332-9077
  • Fax: 334-363-0740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: DR. KIMBERLEY HAYS SMITH
Title or Position: PRESIDENT
Credential: PH.D., BCBA-D
Phone: 334-332-9077