Healthcare Provider Details

I. General information

NPI: 1427462860
Provider Name (Legal Business Name): CHRISTOPHER SMITH PSY. D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 GARDEN AVE STE 111
EUGENE OR
97403-1934
US

IV. Provider business mailing address

1901 GARDEN AVE STE 111
EUGENE OR
97403-1934
US

V. Phone/Fax

Practice location:
  • Phone: 541-515-7800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3041
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: