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General NPI Number Information
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NPI Number | 1902931132
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Entity Type | Individual
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Provider Name | DAVID BRIAN SMOTHERS PSY.D., L.P.
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Gender | Male
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 10425 W NORTH AVE
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City | WAUWATOSA
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State | WI
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Zip | 53226-2416
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Country | US
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Telephone | 414-367-9413
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Fax | 414-358-5590
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Provider Business Mailing Address
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Address Line | 9120 W HAMPTON AVE STE 212 WSPP
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City | MILWAUKEE
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State | WI
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Zip | 53225-4960
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Country | US
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Telephone | 414-464-9777
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3865-125
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License Number State | WI
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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 | 2973-57
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License Number State | WI
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