Provider Demographics
NPI:1972706190
Name:BARBARA JONES SMITH PHD PC
Entity type:Organization
Organization Name:BARBARA JONES SMITH PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:JONES
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:231-947-1444
Mailing Address - Street 1:921 W 11TH ST
Mailing Address - Street 2:1W
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-3002
Mailing Address - Country:US
Mailing Address - Phone:231-947-1444
Mailing Address - Fax:231-947-2444
Practice Address - Street 1:921 W 11TH ST
Practice Address - Street 2:1W
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-3002
Practice Address - Country:US
Practice Address - Phone:231-947-1444
Practice Address - Fax:231-947-2444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007417103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B84653OtherBLUE CROSS BLUE SHIELD
MI0B84653Medicare ID - Type Unspecified