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General NPI Number Information
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NPI Number | 1992652283
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Entity Type | Organization
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Legal Business Name | 1:11 THERAPEUTICS PLLC
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Dates
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Enumeration Date | 03/14/2026
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Last Update Date | 03/14/2026
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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 | 818-515-7991
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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 |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. DERRICK WAYNE SMITH
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Credential | MD
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Telephone | 818-515-7991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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