Provider Demographics
NPI:1912339854
Name:SMITH, CLINTON (BCBA-D)
Entity type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 UNIVERSITY CT
Mailing Address - Street 2:APT A7
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-4002
Mailing Address - Country:US
Mailing Address - Phone:901-230-4914
Mailing Address - Fax:
Practice Address - Street 1:2 UNIVERSITY CT
Practice Address - Street 2:APT A7
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-4002
Practice Address - Country:US
Practice Address - Phone:901-230-4914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst