Healthcare Provider Details

I. General information

NPI: 1851300354
Provider Name (Legal Business Name): PAUL STEVEN SMITH PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N POST RD STE A
INDIANAPOLIS IN
46219-4213
US

IV. Provider business mailing address

1515 N POST RD STE A
INDIANAPOLIS IN
46219-4213
US

V. Phone/Fax

Practice location:
  • Phone: 317-282-3088
  • Fax:
Mailing address:
  • Phone: 317-282-3088
  • Fax: 317-295-3555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number20040450A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number20040450A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number20040450A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20040450A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number20040450A
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number20040450A
License Number StateIN
# 7
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number20040450A
License Number StateIN
# 8
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20040450A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: