Provider Demographics
NPI:1790263721
Name:SMITH, HUSTON CHASE (BA)
Entity Type:Individual
Prefix:MR
First Name:HUSTON
Middle Name:CHASE
Last Name:SMITH
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-1392
Mailing Address - Country:US
Mailing Address - Phone:270-250-5643
Mailing Address - Fax:
Practice Address - Street 1:341 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-1392
Practice Address - Country:US
Practice Address - Phone:270-250-5643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator