Provider Demographics
NPI:1952376303
Name:SMYTHE, STUART WILSON JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:STUART
Middle Name:WILSON
Last Name:SMYTHE
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
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Mailing Address - Street 1:415 WILLOW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2941
Mailing Address - Country:US
Mailing Address - Phone:270-798-8601
Mailing Address - Fax:270-798-8239
Practice Address - Street 1:USA MEDDAC
Practice Address - Street 2:650 JOEL DR
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5349
Practice Address - Country:US
Practice Address - Phone:270-798-8601
Practice Address - Fax:270-798-8239
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY07701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical