MEDICARE: DR. ERIC TECUMSEH SMELTZ PSYD PSYCHOLOGIST

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	PY 1309	WA

General Provider Information

NPI Number	:	1972575108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC TECUMSEH SMELTZ PSYD PSYCHOLOGIST

Provider Business Mailing Address
First Line	:	7805 S ASSEMBLY RD
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99224-5940
Country	:	US
Telephone Number	:	509-981-9999
Fax Number	:

Provider Business Practice Location Address
First Line	:	7805 S ASSEMBLY RD
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99224-5940
Country	:	US
Telephone Number	:	509-981-9999
Fax Number	:

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

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	07/08/2007

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