Provider Demographics
NPI:1528094521
Name:SMITH, ALBERT HILL (PHD,CEAP,Q-SAP)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:HILL
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD,CEAP,Q-SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 HIGHWAY 365
Mailing Address - Street 2:#110
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-6256
Mailing Address - Country:US
Mailing Address - Phone:409-729-0400
Mailing Address - Fax:409-729-0453
Practice Address - Street 1:2300 HIGHWAY 365
Practice Address - Street 2:#110
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-6256
Practice Address - Country:US
Practice Address - Phone:409-729-0400
Practice Address - Fax:409-729-0453
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1585103T00000X
TX33973103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX613764Medicare PIN
TX8L5738Medicare PIN