Provider Demographics
NPI:1619192564
Name:SMITH, NANCY R (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:R
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 S LOOMIS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-2545
Mailing Address - Country:US
Mailing Address - Phone:970-416-1480
Mailing Address - Fax:970-416-1483
Practice Address - Street 1:420 S LOOMIS AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2545
Practice Address - Country:US
Practice Address - Phone:970-416-1480
Practice Address - Fax:970-416-1483
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3632106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist