Provider Demographics
NPI:1437439312
Name:SMITH, JAMES CHARLES (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CHARLES
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:906 C M FAGAN DR
Mailing Address - Street 2:SUITE 5B
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-6056
Mailing Address - Country:US
Mailing Address - Phone:985-345-2440
Mailing Address - Fax:985-345-2440
Practice Address - Street 1:906 C M FAGAN DR
Practice Address - Street 2:SUITE 5B
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-6056
Practice Address - Country:US
Practice Address - Phone:985-345-2440
Practice Address - Fax:985-345-2440
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2015-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA1164103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA365331YJA2Medicare PIN