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General NPI Number Information
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NPI Number | 1316021801
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Entity Type | Organization
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Legal Business Name | WM MICHAEL SMITH PHD PC
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 11/13/2007
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Provider Practice Location Address
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Address Line | 2919 17TH AVE SUITE 210
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City | LONGMONT
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State | CO
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Zip | 80503-1650
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Country | US
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Telephone | 303-651-9290
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Fax | 303-651-7158
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Provider Business Mailing Address
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Address Line | 2727 NELSON RD APT P103
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City | LONGMONT
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State | CO
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Zip | 80503-9383
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Country | US
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Telephone | 303-651-9290
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Fax | 303-651-7158
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM MICHAEL SMITH
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Credential | PHD
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Telephone | 303-651-9290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2110
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License Number State | CO
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