Provider Demographics
NPI:1154531440
Name:SMITH, ROBERT DEAN (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DEAN
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:PO BOX 342
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48805-0342
Mailing Address - Country:US
Mailing Address - Phone:517-349-5987
Mailing Address - Fax:
Practice Address - Street 1:3505 COOLIDGE RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6377
Practice Address - Country:US
Practice Address - Phone:517-349-5987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003249103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680-C3-4617OtherPIN NUMBER
MI680-C3-4617OtherPIN NUMBER