Healthcare Provider Details

I. General information

NPI: 1083931653
Provider Name (Legal Business Name): PATRICIA BAKER SMITH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2010
Last Update Date: 04/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 W 28TH ST
LOVELAND CO
80538-3101
US

IV. Provider business mailing address

1152 OLYMPIA AVE UNIT G
LONGMONT CO
80504-2386
US

V. Phone/Fax

Practice location:
  • Phone: 970-203-1300
  • Fax: 970-203-0222
Mailing address:
  • Phone: 303-776-8011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0701002083
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701002083
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: