Provider Demographics
NPI:1669887063
Name:SMITH, PHILLIP NELSON (PHD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:NELSON
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:UNIVERSITY OF SOUTH ALABAMA
Mailing Address - Street 2:75 S. UNIVERSITY BLVD., UCOM1000
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36688-0001
Mailing Address - Country:US
Mailing Address - Phone:251-460-6690
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF SOUTH ALABAMA
Practice Address - Street 2:75 S. UNIVERSITY BLVD., UCOM1000
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36688-0001
Practice Address - Country:US
Practice Address - Phone:251-460-6690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1746103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical