MEDICARE: GREYSON SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPC.0020812	CO

General Provider Information

NPI Number	:	1093450819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREYSON SMITH

Provider Business Mailing Address
First Line	:	6214 POUDRE WAY
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-5409
Country	:	US
Telephone Number	:	719-355-6062
Fax Number	:

Provider Business Practice Location Address
First Line	:	3455 BRIARGATE BLVD STE 261
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-4100
Country	:	US
Telephone Number	:	720-282-9941
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2022
Last Update Date	:	11/11/2024

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Directions to “ GREYSON SMITH ” Practice Location

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