Provider Demographics
NPI:1144383100
Name:SMITH, KATHRYN REA (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:REA
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:ELIZABETH
Other - Last Name:REA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:679 EMORY VALLEY ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830
Mailing Address - Country:US
Mailing Address - Phone:865-212-5437
Mailing Address - Fax:865-220-0782
Practice Address - Street 1:679 EMORY VALLEY RD.
Practice Address - Street 2:SUITE B
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830
Practice Address - Country:US
Practice Address - Phone:865-212-5437
Practice Address - Fax:865-220-0782
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2226103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling