Healthcare Provider Details

I. General information

NPI: 1750440749
Provider Name (Legal Business Name): STEVE B SMITH PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 W 2ND ST SUITE 207
LEXINGTON KY
40508-9002
US

IV. Provider business mailing address

3363 IRON WORKS RD
GEORGETOWN KY
40324-9105
US

V. Phone/Fax

Practice location:
  • Phone: 859-255-4864
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number0559
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: