Provider Demographics
NPI:1588812200
Name:SMITH, PAUL CORBY (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:CORBY
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 1:1163 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:MI
Mailing Address - Zip Code:49070-9722
Mailing Address - Country:US
Mailing Address - Phone:269-685-2361
Mailing Address - Fax:
Practice Address - Street 1:1163 10TH ST
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:MI
Practice Address - Zip Code:49070-9722
Practice Address - Country:US
Practice Address - Phone:269-685-2361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-06
Last Update Date:2008-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002536103T00000X, 103TA0700X, 103TB0200X, 103TC0700X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities