Healthcare Provider Details

I. General information

NPI: 1679758346
Provider Name (Legal Business Name): AARON MICHAEL SMITH PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE MAMC DEPARTMENT OF PSYCHOLOGY
TACOMA WA
98431-1100
US

IV. Provider business mailing address

9040 JACKSON AVE MAMC DEPARTMENT OF PSYCHOLOGY
TACOMA WA
98431-1100
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-2820
  • Fax: 253-968-3731
Mailing address:
  • Phone: 253-968-2820
  • Fax: 253-968-3731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY 60089685
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY 60089685
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: