Individual
DR. BRENT RODERICK SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
6692 SPRING ARBOR RD, JACKSON, MI 49201
(517) 750-3869
(517) 750-3869
Mailing address
6692 SPRING ARBOR RD, JACKSON, MI 49201-9322
(517) 750-3869
(517) 750-3673
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301008782
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
680C845330
BLUE CROSS BLUE SHIELD MI
MI
Enumeration date
08/19/2006
Last updated
08/17/2018
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