Provider Demographics
NPI:1467505545
Name:SMITH, THOMAS AUSTIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:AUSTIN
Last Name:SMITH
Suffix:
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 1:617 E MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3621
Mailing Address - Country:US
Mailing Address - Phone:317-637-7338
Mailing Address - Fax:317-624-4224
Practice Address - Street 1:617 E MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3621
Practice Address - Country:US
Practice Address - Phone:317-637-7338
Practice Address - Fax:317-624-4224
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20010003A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical