Healthcare Provider Details

I. General information

NPI: 1548497100
Provider Name (Legal Business Name): MARIAN L. SMITH PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2009
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 CLUB MANOR DR STE A
MAUMELLE AR
72113-6088
US

IV. Provider business mailing address

3101 CLUB MANOR DR STE A
MAUMELLE AR
72113-6088
US

V. Phone/Fax

Practice location:
  • Phone: 501-271-8121
  • Fax: 866-573-0780
Mailing address:
  • Phone: 501-271-8121
  • Fax: 866-573-0780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number18-04P
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY10836
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2016032381
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1923
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberT-LP 1800
License Number StateKS
# 6
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number18-04P
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: