Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 2518 | CO |
N | 103T00000X | Psychologist | 2518 | CO |
N | 103TC1900X | Counseling Psychologist | 2518 | CO |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 2518 | CO |
N | 103TF0000X | Family Psychologist | 2518 | CO |
NPI | 1023229739 |
---|---|
Provider Name | Dr. Michael Donald Smith |
First Address | Louisville, CO 80027-1586 |
Second Address | Louisville, CO 80027-1586 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 08/07/2007 |