Provider Demographics
NPI:1336479740
Name:SMITH, COLLEEN F (MA CLINICAL PSYCHOLO)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:F
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA CLINICAL PSYCHOLO
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:F
Other - Last Name:O'PELL-RIDDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3375 US ROUTE 60 E
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-2837
Mailing Address - Country:US
Mailing Address - Phone:304-525-7851
Mailing Address - Fax:304-697-1286
Practice Address - Street 1:3375 US ROUTE 60 E
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2837
Practice Address - Country:US
Practice Address - Phone:304-525-7851
Practice Address - Fax:304-697-1286
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV853103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0005355002Medicaid