| Doctor Name: | DR. MALLOREE JNE SMITH |
| NPI Number: | 1023444171 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSYD |
| License Number: | 2158 |
| Business Practice Address: | 225 Bennett Ave 1st Special Operations Support Squadron Hurlburt Field, FL - 32544 |
| Business Phone Number: | 8504204281 |
| Business Fax Number: | |
| Mailing Address: | 225 Bennett Ave, 1st Special Operations Support Squadron HURLBURT FIELD |
| State: | FL |
| Postal Code: | 32544 |
| Phone Number: | 8504204281 |
| Fax Number: | |
| NPI Enumeration Date: | 09/20/2013 |
| NPI Last Update Date: | 11/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 2158 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KS |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |