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General NPI Number Information
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NPI Number | 1679344170
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Entity Type | Organization
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Legal Business Name | CONSTRUCTIVE PSYCHIATRY, LLC
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Dates
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Enumeration Date | 01/12/2024
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Last Update Date | 09/02/2024
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Provider Practice Location Address
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Address Line | 150 E PALMETTO PARK RD STE 800
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City | BOCA RATON
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State | FL
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Zip | 33432-4833
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Country | US
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Telephone | 561-203-9707
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Fax | 833-574-6120
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Provider Business Mailing Address
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Address Line | 12600 HILL COUNTRY BLVD STE R130-302
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City | AUSTIN
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State | TX
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Zip | 78738-6723
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Country | US
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Telephone | 512-995-8905
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Fax |
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Authorized Official
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Title or Position | CEO, CLINICIAN
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Name | DR. CHRISTOPHER JAMES SMALLWOOD
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Credential | PHD, PMHNP-BC
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Telephone | 512-222-7105
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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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