Provider Demographics
NPI:1225853690
Name:SMITH, DONALD ELLIS
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:ELLIS
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 CEDAR RIDGE LN APT 13
Mailing Address - Street 2:
Mailing Address - City:PARK HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41011-3839
Mailing Address - Country:US
Mailing Address - Phone:859-250-5358
Mailing Address - Fax:
Practice Address - Street 1:8140 DREAM ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-7531
Practice Address - Country:US
Practice Address - Phone:859-250-5358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker