Provider Demographics
NPI:1083089353
Name:SMITH, MICHAEL V JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:V
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8243 S RISING SUN DR
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:IN
Mailing Address - Zip Code:46064-7526
Mailing Address - Country:US
Mailing Address - Phone:058-904-3705
Mailing Address - Fax:
Practice Address - Street 1:8243 S RISING SUN DR
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:IN
Practice Address - Zip Code:46064-7526
Practice Address - Country:US
Practice Address - Phone:317-674-3277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-11
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39004613A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health