Healthcare Provider Details

I. General information

NPI: 1386066678
Provider Name (Legal Business Name): PAUL L SMITH, PHD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2014
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 WALTON BLVD SUITE 210
ROCHESTER HILLS MI
48307-6917
US

IV. Provider business mailing address

15655 33 MILE RD
ARMADA MI
48005-3400
US

V. Phone/Fax

Practice location:
  • Phone: 248-656-8500
  • Fax: 248-656-8600
Mailing address:
  • Phone: 248-656-0206
  • Fax: 248-656-8600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL LUCKI SMITH
Title or Position: OWNER
Credential: PHD
Phone: 248-656-8500