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General NPI Number Information
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NPI Number | 1023870763
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Entity Type | Organization
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Legal Business Name | SMITH PSYCHIATRY LLC
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Dates
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Enumeration Date | 01/29/2024
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Last Update Date | 01/29/2024
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Provider Practice Location Address
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Address Line | 12212 N PARADISE VILLAGE PKWY S APT 143
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City | PHOENIX
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State | AZ
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Zip | 85032-7647
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Country | US
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Telephone | 602-800-4699
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Fax |
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Provider Business Mailing Address
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Address Line | 836 SOUTHAMPTON RD STE B115
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City | BENICIA
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State | CA
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Zip | 94510-1961
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Country | US
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Telephone | 602-800-4699
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MASON SMITH
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Credential |
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Telephone | 602-909-4701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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