Provider Demographics
NPI:1043643935
Name:SMITH, DANIELLE MARIE (PSYD, MSCP)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:
Credentials:PSYD, MSCP
Other - Prefix:DR
Other - First Name:DANIELLE
Other - Middle Name:MARIE
Other - Last Name:MCNEILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD, MSCP
Mailing Address - Street 1:650 JOEL DR
Mailing Address - Street 2:
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-5318
Mailing Address - Country:US
Mailing Address - Phone:270-798-4097
Mailing Address - Fax:
Practice Address - Street 1:650 JOEL DR
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5318
Practice Address - Country:US
Practice Address - Phone:270-798-4097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY168047103TF0200X, 103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist