Provider Demographics
NPI:1861559932
Name:SMITH, DOUG PATRICK (PHD)
Entity type:Individual
Prefix:DR
First Name:DOUG
Middle Name:PATRICK
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3638 DINOSAUR ST
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-3627
Mailing Address - Country:US
Mailing Address - Phone:303-246-7559
Mailing Address - Fax:303-831-9530
Practice Address - Street 1:9088 RIDGELINE BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2383
Practice Address - Country:US
Practice Address - Phone:303-246-7559
Practice Address - Fax:303-831-9530
Is Sole Proprietor?:No
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2512103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO21472238Medicaid
CO21472238Medicaid