Provider Demographics
NPI:1659905206
Name:SMITH, JAMES DONALD (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DONALD
Last Name:SMITH
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:3225 TEMPLETON GAP ROAD STE 102 BOX 12
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907
Mailing Address - Country:US
Mailing Address - Phone:719-445-9720
Mailing Address - Fax:
Practice Address - Street 1:3225 TEMPLETON GAP RD STE 102
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8729
Practice Address - Country:US
Practice Address - Phone:719-445-9720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-22
Last Update Date:2020-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0015949101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
COLPC.0015949OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES, DIVISION OF PROFESSIONS AND OCCUPATI