Justin Mark Smith, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

003910 Issued in AZ

Practice address

1830 S Alma School Rd Ste 112
Mesa, AZ 85210-3086

Phone

(480) 730-6222

NPI assigned

Apr 19, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Arizona Psychology Consultants, Inc.

  • Pastoral Counselor
  • Mesa, AZ
  • NPI 1295852051

  Clinical

  NPD (past)
• Professional Counseling Associates, LLC

  • Marriage & Family Therapist
  • Mesa, AZ
  • NPI 1568581031

  Clinical

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681862400000",
    "number": "1629765722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1830 S ALMA SCHOOL RD STE 112",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852103086",
            "telephone_number": "480-730-6222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1830 S ALMA SCHOOL RD STE 112",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852103086",
            "telephone_number": "480-730-6222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JUSTIN",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-04-19",
        "last_updated": "2023-04-19",
        "certification_date": "2023-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "AZ",
            "license": "003910",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301019264",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "2612-57",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Ryan Smith, MPT
• Jennifer Smith
• Jeremy L Smith, CPHT
• Jessica Lynn Smith, M.A. CCC-SLP
• John Smith
• Katharine Anne Smith, CRNA
• Kathleen Smith
• Kelsey Morgan Smith, M OTR/L
• Kendal Smith, MD
• Keona E Smith, NURSE PRACTITIONER

• Clinical Psychologist in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Clinical Psychologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.