Provider Demographics
NPI:1558403378
Name:SMITH, ALEXANDRA CHILDS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:CHILDS
Last Name:SMITH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:ALEXANDER
Other - Last Name:CHILDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:215 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-3419
Mailing Address - Country:US
Mailing Address - Phone:931-572-9168
Mailing Address - Fax:931-906-5010
Practice Address - Street 1:215 FRANKLIN STREET
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3443
Practice Address - Country:US
Practice Address - Phone:931-572-9168
Practice Address - Fax:931-906-5010
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1937103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3580011OtherPTAN
RI689022212Medicare ID - Type Unspecified