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General NPI Number Information
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NPI Number | 1710269147
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Entity Type | Individual
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Provider Name | CHRISTOPHER LEE SMITH PH.D.
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Gender | Male
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Dates
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Enumeration Date | 09/12/2011
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Last Update Date | 08/07/2023
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Provider Practice Location Address
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Address Line | 709 W RUSK ST STE B838
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City | ROCKWALL
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State | TX
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Zip | 75087-3056
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Country | US
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Telephone | 720-263-6413
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Fax |
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Provider Business Mailing Address
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Address Line | 1035 HIGH COTTON LN
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City | ROCKWALL
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State | TX
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Zip | 75087-2293
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Country | US
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Telephone | 720-263-6413
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 33891
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY.0003727
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License Number State | CO
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