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General NPI Number Information
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NPI Number | 1497176093
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Entity Type | Individual
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Provider Name | CHERYL FUNSCH SMITH PH.D.
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Gender | Female
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Dates
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Enumeration Date | 12/27/2013
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 2031 N GREEN ACRES RD STE A
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-2619
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Country | US
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Telephone | 615-618-5166
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Fax |
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Provider Business Mailing Address
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Address Line | 169 PRINCESS CIR
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City | FRANKLIN
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State | TN
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Zip | 37064-1422
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Country | US
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Telephone | 615-618-5166
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Fax |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS008859L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3206
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 20-07P
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License Number State | AR
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