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1902931132 NPI number — DAVID BRIAN SMOTHERS PSY.D., L.P.

NPI Number: 1902931132
Health Care Provider/Practitioner: DAVID BRIAN SMOTHERS PSY.D., L.P.

Information about “1902931132” NPI (DAVID BRIAN SMOTHERS PSY.D., L.P.) exists in 1902931132 in HTML format HTML  |  1902931132 in plain Text format TXT  |  1902931132 in PDF (Portable Document Format) PDF  |  1902931132 in an XML format XML  formats.

NPI Number : 1902931132 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1902931132",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SMOTHERS",
    "FirstName": "DAVID",
    "MiddleName": "BRIAN",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PSY.D., L.P.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "9120 W HAMPTON AVE STE 212",
    "SecondLineMailingAddress": "WSPP",
    "MailingAddressCityName": "MILWAUKEE",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "53225-4960",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "414-464-9777",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "10425 W NORTH AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WAUWATOSA",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "53226-2416",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "414-367-9413",
    "PracticeLocationAddressFaxNumber": "414-358-5590",
    "EnumerationDate": "02/21/2007",
    "LastUpdateDate": "03/17/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "3865-125",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "2973-57",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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