Healthcare Provider Details

I. General information

NPI: 1467540088
Provider Name (Legal Business Name): JAMES LARRY SMITH M.S., L.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 FIRST AVE. SW, STE 2
ROCHESTER MN
55902-3356
US

IV. Provider business mailing address

732 37TH ST SW
ROCHESTER MN
55902-1282
US

V. Phone/Fax

Practice location:
  • Phone: 507-252-5497
  • Fax: 507-252-5497
Mailing address:
  • Phone: 507-288-7958
  • Fax: 507-252-5497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberMN LP 0653
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: