Basic Information
| Provider Information | |||||||||
| NPI: | 1326473935 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | NEIL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2621 NE 134TH ST | ||||||||
| Address2: | SUITE 340 | ||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986863036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604500140 | ||||||||
| FaxNumber: | 8773430535 | ||||||||
| Practice Location | |||||||||
| Address1: | 2621 NE 134TH ST | ||||||||
| Address2: | SUITE 340 | ||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986863036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604500140 | ||||||||
| FaxNumber: | 8773430535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2013 | ||||||||
| LastUpdateDate: | 09/13/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TB0200X | PY 60214473 | WA | N | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103TC0700X | PY 60214473 | WA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TH0004X | PY 60214473 | WA | N | Behavioral Health & Social Service Providers | Psychologist | Health | 103TH0100X | N | Behavioral Health & Social Service Providers | Psychologist | Health Service | 103TP0814X | PY 60214473 | WA | N | Behavioral Health & Social Service Providers | Psychologist | Psychoanalysis | 103TP2701X | PY 60214473 | WA | N | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy |
No ID Information.