Individual
RAPHAEL G SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY D, HSPP
Contact information
Practice address
4044 CENTRAL ST, KANSAS CITY, MO 64111-2228
(816) 960-4525
Mailing address
4044 CENTRAL ST, KANSAS CITY, MO 64111-2228
(816) 960-4525
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
20041042A
IN
103TC0700X
Clinical Psychologist
Primary
2009038103
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000188733
ANTHEM BLUE CROSS
IN
05
—
200095120
—
IN
01
—
343420
MHN
IN
Enumeration date
12/28/2005
Last updated
02/11/2010
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