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General NPI Number Information
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NPI Number | 1588645907
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Entity Type | Individual
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Provider Name | JAMES WILSON SMITH JR. LMT
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Gender | Male
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Dates
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Enumeration Date | 11/11/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 24945 US HIGHWAY 19 N
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City | CLEARWATER
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State | FL
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Zip | 33763-3927
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Country | US
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Telephone | 727-215-9288
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Fax | 727-724-9705
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Provider Business Mailing Address
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Address Line | PO BOX 651
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City | SAFETY HARBOR
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State | FL
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Zip | 34695-0651
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Country | US
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Telephone | 727-215-9288
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Fax | 727-724-9705
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MA0011524
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License Number State | FL
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