Provider Demographics
NPI:1184203143
Name:SMITH, DAVID V (ED,D)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:V
Last Name:SMITH
Suffix:
Gender:M
Credentials:ED,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 BURNETT DR
Mailing Address - Street 2:
Mailing Address - City:EKRON
Mailing Address - State:KY
Mailing Address - Zip Code:40117-8900
Mailing Address - Country:US
Mailing Address - Phone:502-389-6654
Mailing Address - Fax:
Practice Address - Street 1:2133 W MARKET ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40212-1532
Practice Address - Country:US
Practice Address - Phone:502-384-5807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist