Provider Demographics
NPI:1356127526
Name:SMITH, ADAM HARRISON
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:HARRISON
Last Name:SMITH
Suffix:
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 1:303 JAY AVE
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-3880
Mailing Address - Country:US
Mailing Address - Phone:870-310-8538
Mailing Address - Fax:
Practice Address - Street 1:303 JAY AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-3880
Practice Address - Country:US
Practice Address - Phone:870-310-8538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst