Provider Demographics
NPI:1003027343
Name:SMITH, SHAWN T (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:T
Last Name:SMITH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12902 W 24TH PL
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-2221
Mailing Address - Country:US
Mailing Address - Phone:303-818-5162
Mailing Address - Fax:303-399-0650
Practice Address - Street 1:121 S MADISON ST STE B
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3019
Practice Address - Country:US
Practice Address - Phone:303-818-5162
Practice Address - Fax:303-399-0650
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor