Provider Demographics
NPI:1043402167
Name:KEVIN G. SMITH PHD AND ASSOCIATES
Entity Type:Organization
Organization Name:KEVIN G. SMITH PHD AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:713-795-5151
Mailing Address - Street 1:PO BOX 541633
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77254-1633
Mailing Address - Country:US
Mailing Address - Phone:713-795-5151
Mailing Address - Fax:
Practice Address - Street 1:4318 STANFORD ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-5930
Practice Address - Country:US
Practice Address - Phone:713-795-5151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KEVIN G. SMITH PHD AND ASSOICATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-13
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R29RMedicare PIN