Michael Scott Smith, PSY

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY004636 Issued in GA

Practice address

610 Ridley Ave
Lagrange, GA 30240-2236

Phone

(706) 884-5050

NPI assigned

Sep 7, 2017

Last updated

Jan 31, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Clinical Psychologist

Education

Mercer University School of Medicine, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Counseling Services of Lagrange, Inc.

  • Clinical Psychologist
  • Lagrange, GA
  • NPI 1790197804
  NPD

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

{
    "created_epoch": "1504742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675123200000",
    "number": "1700304904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 RIDLEY AVE",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302402236",
            "telephone_number": "706-884-5050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 RIDLEY AVE",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302402236",
            "telephone_number": "706-884-5050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MICHAEL",
        "middle_name": "SCOTT",
        "credential": "PSY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-09-07",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC009754",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY004636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ericia Smith, CPB, CCS, A.S.T
• John Connor Smith, M.D.
• Katherine Marie Smith, RPH
• Kelsey Hammond Smith, CNP
• Laura Leigh Smith, PT
• Natalie R Smith, PHARMD
• Shaquavia Kiana Smith
• Shauntrell Smith, LMSW
• Shaynell Smith
• William Smith, NP

• Clinical Psychologist in Lagrange, GA
• Providers in Lagrange, GA by specialty
• Clinical Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.

Verify at the official NPI Registry.