Provider Demographics
NPI:1043946130
Name:SMITH, JEREMY KYLE
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:KYLE
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7220 W JEFFERSON AVE STE 404
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80235-2016
Mailing Address - Country:US
Mailing Address - Phone:720-678-9400
Mailing Address - Fax:
Practice Address - Street 1:7220 W JEFFERSON AVE STE 404
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235-2016
Practice Address - Country:US
Practice Address - Phone:720-678-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health