Provider Demographics
NPI:1750472718
Name:SMITH, JAMES E (PHD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
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 1:1740 FRANKLIN CHASE TER
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-3473
Mailing Address - Country:US
Mailing Address - Phone:702-343-2595
Mailing Address - Fax:
Practice Address - Street 1:1590 W SUNSET RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6633
Practice Address - Country:US
Practice Address - Phone:702-486-6700
Practice Address - Fax:702-486-0559
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0509103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV101527Medicare ID - Type Unspecified