Individual
MARK RANDALL SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
904 HWY 15 SOUTH FRONTAGE RD., SUITE H, HUTCHINSON, MN 55350
(320) 587-2939
(320) 864-1927
Mailing address
904 HWY 15 SOUTH FRONTAGE RD., SUITE H, HUTCHINSON, MN 55350
(320) 587-2939
(320) 864-1927
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP2907
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004049
AETNA
—
01
—
030701079
PRIME WEST HEALTH SYST
—
01
—
112964
CHOICE PLUS
—
01
—
115129
UCARE
MN
01
—
24981
HEALTH PARTNERS
—
05
—
262248300
—
MN
01
—
53308SM
BC
MN
01
—
6120057
UNITED BEH HEALTH
—
01
—
98520
BC
IA
01
—
990991000146
PREFERRED ONE/BHP
—
Enumeration date
09/07/2005
Last updated
10/30/2008
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