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General NPI Number Information
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NPI Number | 1750941365
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Entity Type | Individual
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Provider Name | DR. KRISTEN MARIE SMITH
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Gender | Female
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Dates
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Enumeration Date | 06/17/2019
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Last Update Date | 06/17/2019
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Provider Practice Location Address
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Address Line | 3125 INDEPENDENCE DR STE 114
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City | BIRMINGHAM
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State | AL
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Zip | 35209-4163
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Country | US
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Telephone | 513-288-7582
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Fax |
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Provider Business Mailing Address
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Address Line | 4521 LINPARK DR
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City | BIRMINGHAM
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State | AL
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Zip | 35222-3711
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Country | US
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Telephone | 513-288-7582
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2119
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License Number State | AL
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