Healthcare Provider Details

I. General information

NPI: 1548628126
Provider Name (Legal Business Name): ANDREW SMITH LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 05/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 DIVISION ST SUITE 301
NASHVILLE TN
37203-2732
US

IV. Provider business mailing address

55 JAY ST
NASHVILLE TN
37210-5219
US

V. Phone/Fax

Practice location:
  • Phone: 615-925-3886
  • Fax:
Mailing address:
  • Phone: 615-925-3886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1115
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: