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General NPI Number Information
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NPI Number | 1093680985
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Entity Type | Individual
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Provider Name | TIMOTHY DEAN SMITH
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Gender | Male
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Dates
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Enumeration Date | 10/09/2025
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 5497 LIBERTY AVE APT B
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City | VERMILION
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State | OH
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Zip | 44089-1385
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Country | US
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Telephone | 440-980-7159
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Fax | 440-259-6802
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Provider Business Mailing Address
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Address Line | 5497 LIBERTY AVE APT B
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City | VERMILION
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State | OH
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Zip | 44089-1385
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Country | US
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Telephone | 440-320-7159
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Fax | 440-259-6802
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | OH
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