Healthcare Provider Details

I. General information

NPI: 1508785858
Provider Name (Legal Business Name): ENRIQUE SMITH LP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 AUTOMATION WAY UNIT C4
FORT COLLINS CO
80525-3447
US

IV. Provider business mailing address

1224 23RD AVENUE CT
GREELEY CO
80634-3512
US

V. Phone/Fax

Practice location:
  • Phone: 970-573-7528
  • Fax:
Mailing address:
  • Phone: 901-359-0955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY.0006472
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: