Healthcare Provider Details

I. General information

NPI: 1053623199
Provider Name (Legal Business Name): DAVID JOEL SMITH M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6507 S SANTA FE DR
LITTLETON CO
80120-2910
US

IV. Provider business mailing address

3880 OSCEOLA ST
DENVER CO
80212-2141
US

V. Phone/Fax

Practice location:
  • Phone: 303-730-0797
  • Fax:
Mailing address:
  • Phone: 303-480-5367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: