Provider Demographics
NPI:1134262553
Name:SMITH, BUREN STEVE JR (PHD)
Entity type:Individual
Prefix:DR
First Name:BUREN
Middle Name:STEVE
Last Name:SMITH
Suffix:JR
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 1:2500 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-815-0853
Mailing Address - Fax:601-984-5452
Practice Address - Street 1:701 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MS
Practice Address - Zip Code:39345
Practice Address - Country:US
Practice Address - Phone:601-683-4377
Practice Address - Fax:601-683-4270
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS34-559103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS16899760OtherDEPT. OF LABOR
MS680000253Medicare ID - Type UnspecifiedPSYCHOLOGIST
MSS40803Medicare UPIN