Provider Demographics
NPI:1811584071
Name:SMITH, JAMES THOMAS III
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:THOMAS
Last Name:SMITH
Suffix:III
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 1:4343 N 52ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-2895
Mailing Address - Country:US
Mailing Address - Phone:402-457-7195
Mailing Address - Fax:
Practice Address - Street 1:4343 N 52ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-2895
Practice Address - Country:US
Practice Address - Phone:402-457-7195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE73891041C0700X
NE11947101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical