Provider Demographics
NPI:1700391422
Name:SMITH, COLLIN ROBLEY
Entity Type:Individual
Prefix:
First Name:COLLIN
Middle Name:ROBLEY
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-7674
Mailing Address - Country:US
Mailing Address - Phone:509-392-9547
Mailing Address - Fax:
Practice Address - Street 1:1207 OXFORD AVE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-7674
Practice Address - Country:US
Practice Address - Phone:509-392-9547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst