Provider Demographics
NPI:1225496391
Name:SMITH, CHRISTOPHER LEE (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:M
Credentials:APRN, PMHNP-BC
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Other - First Name:
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Mailing Address - Street 1:409 W 400 S
Mailing Address - Street 2:THE FOURTH STREET CLINIC
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101
Mailing Address - Country:US
Mailing Address - Phone:385-234-5705
Mailing Address - Fax:801-364-0161
Practice Address - Street 1:409 W 400 S
Practice Address - Street 2:THE FOURTH STREET CLINIC
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101
Practice Address - Country:US
Practice Address - Phone:385-234-5705
Practice Address - Fax:801-364-0161
Is Sole Proprietor?:No
Enumeration Date:2016-02-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT65978714405363L00000X
UT6597871-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner