Basic Information
| Provider Information | |||||||||
| NPI: | 1902931132 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMOTHERS | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | BRIAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSY.D., L.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9120 W HAMPTON AVE STE 212 | ||||||||
| Address2: | WSPP | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532254960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144649777 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10425 W NORTH AVE | ||||||||
| Address2: | |||||||||
| City: | WAUWATOSA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532262416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143679413 | ||||||||
| FaxNumber: | 4143585590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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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 | 101YP2500X | 3865-125 | WI | N | Behavioral Health & Social Service Providers | Counselor | Professional | 103TC0700X | 2973-57 | WI | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | MA 43599400 | 05 | WI | MEDICAID |