Healthcare Provider Details

I. General information

NPI: 1427624683
Provider Name (Legal Business Name): HOLLY L SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 FORT ROOTS DR
NORTH LITTLE ROCK AR
72114-1709
US

IV. Provider business mailing address

11703 HARVICK AVE
BAKERSFIELD CA
93312-6762
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-1000
  • Fax:
Mailing address:
  • Phone: 661-699-3989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810009419
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: