Healthcare Provider Details

I. General information

NPI: 1821580903
Provider Name (Legal Business Name): JAMES WILLIAM SMITH QBHS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 ASHWOOD DR
TIFFIN OH
44883-1908
US

IV. Provider business mailing address

1925 HAYES AVE
SANDUSKY OH
44870-4737
US

V. Phone/Fax

Practice location:
  • Phone: 419-448-9440
  • Fax:
Mailing address:
  • Phone: 517-741-9557
  • Fax: 517-941-9557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: