Provider Demographics
NPI:1467261149
Name:SMITH, MICHAEL DONOVAN (RBT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DONOVAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 SUNRIDGE POINT DR
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-5930
Mailing Address - Country:US
Mailing Address - Phone:931-210-8552
Mailing Address - Fax:
Practice Address - Street 1:31 DANIEL DR
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-6030
Practice Address - Country:US
Practice Address - Phone:931-210-8552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRBT-24-350673106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician