Active NPI
Judy L Smith, PHD
- Clinical Psychologist
- Memphis, TN
National Provider Identifier
1366555146
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- P1046
- Practice address
- 641 Oakleaf Office LN
Suite 3
Memphis, TN 38117-4819 - Phone
- (901) 680-0080
- Fax
- (901) 383-1507
- NPI assigned
- Aug 16, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | P1046 | TN | Primary |
Addresses
Primary practice location
641 Oakleaf Office LN
Suite 3
Memphis, TN 38117-4819
Mailing address
641 Oakleaf Office LN
Suite 3
Memphis, TN 38117-4819
Phone (901) 680-0080
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0127281 | Other | TN | BCBS ID NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040503001169 | TN | Practitioner - Clinical Psychologist | 8628066388 | Practice locations: Memphis, TN |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Texas Tech University Health Science Center School of Medicine, 1984
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
5374 Estate Office Park Dr
Suite 3
Memphis, TN 38119-3650
Phone (901) 680-0080
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P1046 | TN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1366555146",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "641 OAKLEAF OFFICE LN",
"address_2": "SUITE 3",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381174819",
"telephone_number": "901-680-0080",
"fax_number": "901-383-1507"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "641 OAKLEAF OFFICE LN",
"address_2": "SUITE 3",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381174819",
"telephone_number": "901-680-0080",
"fax_number": "901-383-1507"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "JUDY",
"middle_name": "L",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TN",
"license": "P1046",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS ID NUMBER",
"identifier": "0127281",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.