Smith, Raphael G

Smith, Raphael G is an sole proprietor health care provider with primary practice located at 4044 Central St , Kansas City MO 64111-2228. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Smith, Raphael G can be contacted via phone (816) 960-4525.

Contact Information

Primary practice address
4044 Central St Kansas City MO 64111-2228
Phone: (816) 960-4525
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 20041042A Indiana
Behavioral Health & Social Service Providers / Clinical 103TC0700X 2009038103 Missouri

Profile Details

NPI number 1093792392
LBN Legal business name Smith, Raphael G
Credentials PSY D, HSPP
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 28th, 2005
Last updated Feb 11th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1093792392 NPPES
Indiana Other 343420 MHN
Indiana Other 000000188733 MHN
Indiana MEDICAID 200095120 MHN

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