Healthcare Provider Details

I. General information

NPI: 1235520669
Provider Name (Legal Business Name): DR HEATHER SMITH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2015
Last Update Date: 03/12/2021
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12021 PENNSYLVANIA ST STE 205
THORNTON CO
80241-3152
US

IV. Provider business mailing address

12021 PENNSYLVANIA ST STE 205
THORNTON CO
80241-3152
US

V. Phone/Fax

Practice location:
  • Phone: 720-263-1185
  • Fax: 720-263-2817
Mailing address:
  • Phone: 720-263-1185
  • Fax: 720-263-2817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number3984
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HEATHER ANNE SMITH
Title or Position: OWNER
Credential: PH.D.
Phone: 720-263-1185