Provider Demographics
NPI:1679094536
Name:SMITH, BEN N IV (PHD)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:N
Last Name:SMITH
Suffix:IV
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 1:331 BEAR CAGE RD
Mailing Address - Street 2:
Mailing Address - City:ROAN MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37687-3830
Mailing Address - Country:US
Mailing Address - Phone:847-924-8095
Mailing Address - Fax:
Practice Address - Street 1:11550 ANDERSON RD
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-7234
Practice Address - Country:US
Practice Address - Phone:847-924-8095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling