Provider Demographics
NPI:1700332467
Name:SMITH, HEARLEY
Entity Type:Individual
Prefix:DR
First Name:HEARLEY
Middle Name:
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 1:5455 S FORT APACHE RD
Mailing Address - Street 2:108
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-6408
Mailing Address - Country:US
Mailing Address - Phone:708-236-9147
Mailing Address - Fax:
Practice Address - Street 1:5455 S. FORT APACHE RD
Practice Address - Street 2:108
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148
Practice Address - Country:US
Practice Address - Phone:702-817-5211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral