Healthcare Provider Details

I. General information

NPI: 1053829523
Provider Name (Legal Business Name): JASON AARON SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23645 MERCANTILE RD STE B
BEACHWOOD OH
44122-5936
US

IV. Provider business mailing address

23645 MERCANTILE RD STE B
BEACHWOOD OH
44122-5936
US

V. Phone/Fax

Practice location:
  • Phone: 888-830-1672
  • Fax:
Mailing address:
  • Phone: 888-830-1672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133004745
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberCOBA.01970
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: