Healthcare Provider Details

I. General information

NPI: 1326473935
Provider Name (Legal Business Name): NEIL SMITH PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 NE 134TH ST SUITE 340
VANCOUVER WA
98686-3036
US

IV. Provider business mailing address

2621 NE 134TH ST SUITE 340
VANCOUVER WA
98686-3036
US

V. Phone/Fax

Practice location:
  • Phone: 360-450-0140
  • Fax: 877-343-0535
Mailing address:
  • Phone: 360-450-0140
  • Fax: 877-343-0535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPY 60214473
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY 60214473
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPY 60214473
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License NumberPY 60214473
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPY 60214473
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: