Healthcare Provider Details

I. General information

NPI: 1649938291
Provider Name (Legal Business Name): DONAVEN BLAKE SMITH MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4851 INDEPENDENCE ST FL 1
WHEAT RIDGE CO
80033-6715
US

IV. Provider business mailing address

PO BOX 12307
DENVER CO
80212-0307
US

V. Phone/Fax

Practice location:
  • Phone: 303-432-5115
  • Fax:
Mailing address:
  • Phone: 720-626-1285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: