Basic Information
| Provider Information | |||||||||
| NPI: | 1437283298 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | R | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 S ROCK CREEK PKWY APT 41-202 | ||||||||
| Address2: | |||||||||
| City: | SUPERIOR | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800274510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034992853 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1733 VINE ST | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802061119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035041000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | X | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | X | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.