MEDICARE: SMITHSON CLINIC, INC.

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 904	CO
2	171100000X	Acupuncturist	448	CO

General Provider Information

NPI Number	:	1588941561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMITHSON CLINIC, INC.

Provider Business Mailing Address
First Line	:	2825 VALLEJO ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-4312
Country	:	US
Telephone Number	:	303-762-8994
Fax Number	:	720-855-3710

Provider Business Practice Location Address
First Line	:	2825 VALLEJO ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-4312
Country	:	US
Telephone Number	:	303-762-8994
Fax Number	:	720-855-3710

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	MRS. MELANIE BETH SMITHSON
Credential	:	LPC, BCDMT
Telephone Number	:	303-762-8994

Provider Enumeration Date	:	11/04/2011
Last Update Date	:	11/04/2011

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