Healthcare Provider Details

I. General information

NPI: 1457457053
Provider Name (Legal Business Name): RICHARD LEE SMOOT PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 HOSPITAL DR STE 5A
HENDERSONVILLE NC
28792-5247
US

IV. Provider business mailing address

6214 INTERBAY AVE
TAMPA FL
33611-4907
US

V. Phone/Fax

Practice location:
  • Phone: 828-684-1115
  • Fax: 828-687-6064
Mailing address:
  • Phone: 813-832-3267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY 7202
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4158
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: