Provider Demographics
NPI:1447764543
Name:SMITH, DOUGLAS BRADFORD (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:BRADFORD
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 20TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1515
Mailing Address - Country:US
Mailing Address - Phone:806-786-0327
Mailing Address - Fax:
Practice Address - Street 1:8200 NASHVILLE AVE STE 203
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1906
Practice Address - Country:US
Practice Address - Phone:806-786-0327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201423101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health