Provider Demographics
NPI:1457639973
Name:SMYLY, REX H (PSYD)
Entity Type:Individual
Prefix:DR
First Name:REX
Middle Name:H
Last Name:SMYLY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 WILLOW CREEK RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1124
Mailing Address - Country:US
Mailing Address - Phone:928-445-0744
Mailing Address - Fax:928-445-0537
Practice Address - Street 1:1660 WILLOW CREEK RD
Practice Address - Street 2:SUITE A
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1124
Practice Address - Country:US
Practice Address - Phone:928-445-0744
Practice Address - Fax:928-445-0537
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-10486103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical