Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | IN | |
N | 103T00000X | Psychologist | IN | |
N | 102L00000X | Psychologist | 20041353A | IN |
N | 103T00000X | Psychologist | 20041353A | IN |
Y | 102L00000X | Psychologist | 6301010743 | MI |
Y | 103T00000X | Psychologist | 6301010743 | MI |
NPI | 1003881533 |
---|---|
Provider Name | Dr. Harold B Smith |
First Address | Berrien Springs, MI 49103 |
Second Address | Berrien Springs, MI 49103-1664 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2006 |
Last Update Date | 08/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003881533 | (05) | MI |
ON12920 | RR MEDICARE (01) | |
S08381 | (02) | MI |