MEDICARE: KEVIN G SMITH 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	2-4835	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2-4835	OTHER	TX	LICENSE NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700927167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN G SMITH PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 541633
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77254-1633
Country	:	US
Telephone Number	:	713-795-5151
Fax Number	:	713-795-5255

Provider Business Practice Location Address
First Line	:	4203 YOAKUM BLVD STE 170
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77006-5455
Country	:	US
Telephone Number	:	713-795-5151
Fax Number	:	713-795-5255

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

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	11/22/2024

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