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:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1093792392 | NPPES |
| Indiana | Other | 343420 | MHN |
| Indiana | Other | 000000188733 | MHN |
| Indiana | MEDICAID | 200095120 | MHN |
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