Provider Demographics
NPI:1922322916
Name:SMITH, KIMBERLEY H (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:H
Last Name:SMITH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 OPELIKA RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-3981
Mailing Address - Country:US
Mailing Address - Phone:334-826-1847
Mailing Address - Fax:334-821-9601
Practice Address - Street 1:421 OPELIKA RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-3981
Practice Address - Country:US
Practice Address - Phone:334-826-1847
Practice Address - Fax:334-821-9601
Is Sole Proprietor?:No
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-06-2799103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL630854115OtherTRICARE