Provider Demographics
NPI:1558706846
Name:SMITH, DOUGLAS C (PHD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:C
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:PO BOX 503010
Mailing Address - Street 2:
Mailing Address - City:WHITE CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97503-0813
Mailing Address - Country:US
Mailing Address - Phone:541-941-7792
Mailing Address - Fax:503-416-4662
Practice Address - Street 1:542 WASHINGTON ST
Practice Address - Street 2:STE 101
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1796
Practice Address - Country:US
Practice Address - Phone:541-770-0303
Practice Address - Fax:503-419-4662
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1980103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist