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Patrick O Smith

Psychologist

Behavioral Health & Social Service Providers

PECOS Enrollment

Based on the most recent information from CMS, provider Patrick O Smith does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1225126881
Provider Type
Individual
Full Name
Smith, Patrick O
Title
Mr.
Credential
P.H.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
10/10/2006
Last Updated
2/13/2014

Contact Information

Practice Location

878 Lakeland Dr, Jackson, MS 39216-4644

(601) 984-6800

(601) 984-6812

Mailing Location

PO Box 4999, Jackson, MS 39296-4999

(601) 984-5410

(601) 815-3771

Provider Taxonomies

Code	Description	License
Code 103TC0700X Primary	Description Psychologist Behavioral Health & Social Service Providers	License 32-480 Mississippi

Provider Identifiers

ID	Description	Issuer
ID 03537326	Description Medicaid	Issuer Unlisted Mississippi

Patrick O Smith

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Gabriele, Jeanne Marisa

Logan, Patricia

Taravella, Cicely C.

Burgess, Danny Ray

Bailey, Mary Sheree

Moore, Shannon Monique

Marion Counseling Services, Pllc

Dehon, Erin

Lott, William C

Sutton, Monica J