| Doctor Name: | MICHAEL SMITH |
| NPI Number: | 1346273174 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD, HSPP |
| License Number: | 20041599 |
| Business Practice Address: | 1211 E National Ave Brazil, IN - 478342717 |
| Business Phone Number: | 8124488801 |
| Business Fax Number: | 8124465302 |
| Mailing Address: | Po Box 4323, TERRE HAUTE |
| State: | IN |
| Postal Code: | 478040323 |
| Phone Number: | 8122318323 |
| Fax Number: | 8122318400 |
| NPI Enumeration Date: | 07/07/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 20041599 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |