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Individual

MR. W KELLAR SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MA

Contact information

Practice address
1022 A N MAIN ST, AVADA BLDG 2ND FLOOR, BUTLER, PA 16001
(724) 283-8622
Mailing address
356 BRUIN RD, PETROLIA, PA 16050
(724) 753-2650

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS007665L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01972890
PA
Enumeration date
11/22/2006
Last updated
07/08/2007
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