Provider Demographics
NPI:1700189099
Name:SMITH, TRICIA LEANNIE (MS PSYCHOLOGIST ASSO)
Entity Type:Individual
Prefix:MS
First Name:TRICIA
Middle Name:LEANNIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS PSYCHOLOGIST ASSO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:837 ALDER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8911
Mailing Address - Country:US
Mailing Address - Phone:541-608-3878
Mailing Address - Fax:541-608-3880
Practice Address - Street 1:837 ALDER CREEK DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8911
Practice Address - Country:US
Practice Address - Phone:541-608-3878
Practice Address - Fax:541-608-3880
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5057103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical