Provider Demographics
NPI:1275590648
Name:SMITH, HARWELL F III (PHD)
Entity Type:Individual
Prefix:DR
First Name:HARWELL
Middle Name:F
Last Name:SMITH
Suffix:III
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 1:343 WALLER AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2919
Mailing Address - Country:US
Mailing Address - Phone:859-276-1836
Mailing Address - Fax:859-276-0609
Practice Address - Street 1:343 WALLER AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2919
Practice Address - Country:US
Practice Address - Phone:859-276-1836
Practice Address - Fax:859-276-0609
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0467103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY89007637Medicaid
KY000000067888OtherANTHEM BCBS
5904469OtherAETNA
KYCP00033Medicare ID - Type Unspecified