MEDICARE: DR. HARWELL F SMITH III PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	KY0467	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000067888	OTHER	KY	ANTHEM BCBS
3	5904469	OTHER		AETNA

General Provider Information

NPI Number	:	1275590648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HARWELL F SMITH III PH.D.

Provider Business Mailing Address
First Line	:	343 WALLER AVE
Second Line	:	SUITE 300
City	:	LEXINGTON
State	:	KY
Zip	:	40504-2919
Country	:	US
Telephone Number	:	859-276-1836
Fax Number	:	859-276-0609

Provider Business Practice Location Address
First Line	:	343 WALLER AVE
Second Line	:	SUITE 300
City	:	LEXINGTON
State	:	KY
Zip	:	40504-2919
Country	:	US
Telephone Number	:	859-276-1836
Fax Number	:	859-276-0609

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	05/28/2013

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