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NPI Code Detail

MEDICARE: DUNAMYS TELEPSYCHIATRY PLLC

MEDICARE: DUNAMYS TELEPSYCHIATRY PLLC
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
1101YM0800XMental Health Counselor
22084P0800XPsychiatry Physician

General Provider Information

NPI Number : 1265389555
Entity Type Code : Organization
Provider Name (Legal Business Name) : DUNAMYS TELEPSYCHIATRY PLLC
Provider Business Mailing Address
First Line : 507 BROMPTON LN
Second Line :
City : BOSSIER CITY
State : LA
Zip : 71111-8208
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7500 BANNER WAY NE
Second Line :
City : SEATTLE
State : WA
Zip : 98115-4176
Country : US
Telephone Number : 818-515-7991
Fax Number :
Authorized Official
Title or Position : CEO
Name : DR. DERRICK WAYNE SMITH
Credential : MD
Telephone Number : 818-515-7991
Provider Enumeration Date : 03/14/2026
Last Update Date : 03/14/2026

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