Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | PY 60214473 | WA |
Y | 103G00000X | Clinical Psychologist | PY 60214473 | WA |
Y | 103TC0700X | Clinical Psychologist | PY 60214473 | WA |
N | 103TH0004X | Health Psychologist | PY 60214473 | WA |
N | 103TH0100X | Health Service | ||
N | 103TP0814X | Psychoanalysis | PY 60214473 | WA |
N | 103TP2701X | Group Psychotherapist | PY 60214473 | WA |
NPI | 1326473935 |
---|---|
Provider Name | Dr. Neil Smith |
First Address | Vancouver, WA 98686-3036 |
Second Address | Vancouver, WA 98686-3036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2013 |
Last Update Date | 13/09/2013 |