Provider Demographics
NPI:1629222443
Name:SMITH, BARNEY ELBERT (BS)
Entity Type:Individual
Prefix:MR
First Name:BARNEY
Middle Name:ELBERT
Last Name:SMITH
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 05903
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-5903
Mailing Address - Country:US
Mailing Address - Phone:313-526-7116
Mailing Address - Fax:
Practice Address - Street 1:18954 JAMES COUZENS FWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2516
Practice Address - Country:US
Practice Address - Phone:313-864-5306
Practice Address - Fax:313-864-5326
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)