Healthcare Provider Details

I. General information

NPI: 1285039933
Provider Name (Legal Business Name): JOELLE SMITH PSY. D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6065 S QUEBEC ST STE 202
GREENWOOD VILLAGE CO
80111-4532
US

IV. Provider business mailing address

100 WEST FRONTIER #1616
PAYSON AZ
85547
US

V. Phone/Fax

Practice location:
  • Phone: 303-910-1755
  • Fax:
Mailing address:
  • Phone: 303-910-1755
  • Fax: 602-693-0309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number3335
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3335
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number3335
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number3335
License Number StateCO
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3335
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: