Healthcare Provider Details

I. General information

NPI: 1902931132
Provider Name (Legal Business Name): DAVID BRIAN SMOTHERS PSY.D., L.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10425 W NORTH AVE
WAUWATOSA WI
53226-2416
US

IV. Provider business mailing address

9120 W HAMPTON AVE STE 212 WSPP
MILWAUKEE WI
53225-4960
US

V. Phone/Fax

Practice location:
  • Phone: 414-367-9413
  • Fax: 414-358-5590
Mailing address:
  • Phone: 414-464-9777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3865-125
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2973-57
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: