Provider Demographics
NPI:1316021801
Name:WM MICHAEL SMITH PHD PC
Entity Type:Organization
Organization Name:WM MICHAEL SMITH PHD PC
Other - Org Name:ROCKY MOUNTAIN PSYCHOLOGICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:303-651-9290
Mailing Address - Street 1:2727 NELSON RD APT P103
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-9383
Mailing Address - Country:US
Mailing Address - Phone:303-651-9290
Mailing Address - Fax:303-651-7158
Practice Address - Street 1:2919 17TH AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-1650
Practice Address - Country:US
Practice Address - Phone:303-651-9290
Practice Address - Fax:303-651-7158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2110103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07211014Medicaid