Provider Demographics
NPI:1003881533
Name:SMITH, HAROLD B (PYSD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:B
Last Name:SMITH
Suffix:
Gender:M
Credentials:PYSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9067 US 31
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103
Mailing Address - Country:US
Mailing Address - Phone:269-471-9892
Mailing Address - Fax:
Practice Address - Street 1:9067 US HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:BERRIEN SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49103-1664
Practice Address - Country:US
Practice Address - Phone:269-277-0549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010743103T00000X
IN20041353A103T00000X
IN103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ON12920OtherRR MEDICARE
MI1003881533Medicaid
MION12920Medicare PIN
MI1003881533Medicaid