Provider Demographics
NPI:1881660967
Name:SMITH, DARRELL (PHD)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:
Last Name:SMITH
Suffix:
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 1:120 BALLEROY DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4035
Mailing Address - Country:US
Mailing Address - Phone:615-377-7797
Mailing Address - Fax:615-377-7760
Practice Address - Street 1:120 BALLEROY DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4035
Practice Address - Country:US
Practice Address - Phone:615-377-7797
Practice Address - Fax:615-377-7760
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2007-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP2225103TC0700X
103TC1900X, 103TF0000X, 103TB0200X, 103TP2701X, 103T00000X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN044370OtherVALUEOPTIONS