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General NPI Number Information
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NPI Number | 1225121023
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Entity Type | Individual
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Provider Name | PAUL L SMOCK PH.D.
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 06/16/2010
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Provider Practice Location Address
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Address Line | 134 N WATER ST
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City | LIBERTY
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State | MO
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Zip | 64068-1737
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Country | US
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Telephone | 816-781-6690
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Fax | 816-781-2897
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Provider Business Mailing Address
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Address Line | 134 N WATER ST
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City | LIBERTY
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State | MO
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Zip | 64068-1737
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Country | US
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Telephone | 816-781-6690
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Fax | 816-781-2897
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY00383
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License Number State | MO
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