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General NPI Number Information
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NPI Number | 1750546412
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Entity Type | Individual
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Provider Name | DERRICK WAYNE SMITH MD, LMHCA, MA
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Gender | Male
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Dates
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Enumeration Date | 07/22/2008
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 7500 BANNER WAY NE
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City | SEATTLE
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State | WA
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Zip | 98115-4176
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Country | US
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Telephone | 206-427-4679
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Fax |
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Provider Business Mailing Address
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Address Line | 507 BROMPTON LN
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City | BOSSIER CITY
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State | LA
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Zip | 71111-8208
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Country | US
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Telephone | 818-515-7991
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD.61597266
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License Number State | WA
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