Provider Demographics
NPI:1407381270
Name:SMITH, CHRISTA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8158 E 5TH AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6446
Mailing Address - Country:US
Mailing Address - Phone:720-536-5776
Mailing Address - Fax:
Practice Address - Street 1:8158 E 5TH AVE STE 260
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-6446
Practice Address - Country:US
Practice Address - Phone:720-536-5776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3375103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical