Provider Demographics
NPI:1285039933
Name:SMITH, JOELLE (PSY D)
Entity Type:Individual
Prefix:DR
First Name:JOELLE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WEST FRONTIER #1616
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85547
Mailing Address - Country:US
Mailing Address - Phone:303-910-1755
Mailing Address - Fax:602-693-0309
Practice Address - Street 1:6065 S QUEBEC ST STE 202
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-4532
Practice Address - Country:US
Practice Address - Phone:303-910-1755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3335103TB0200X, 103TC1900X, 103TC2200X, 103TF0000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1285039933OtherNPI
CO1841671385OtherBUSINESS NPI
CO415474ZPH5OtherMEDICARE PTAN