Provider Demographics
NPI:1679344170
Name:DR. CHRISTOPHER J. SMALLWOOD, LLC
Entity Type:Organization
Organization Name:DR. CHRISTOPHER J. SMALLWOOD, LLC
Other - Org Name:DRSMALLWOOD.COM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO, CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SMALLWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PMHNP-BC
Authorized Official - Phone:612-039-7075
Mailing Address - Street 1:4845 PEARL EAST CIRCLE STE 118
Mailing Address - Street 2:PMB 38389
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301
Mailing Address - Country:US
Mailing Address - Phone:561-203-9707
Mailing Address - Fax:833-574-6120
Practice Address - Street 1:150 E PALMETTO PARK RD STE 800
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-4833
Practice Address - Country:US
Practice Address - Phone:561-203-9707
Practice Address - Fax:833-574-6120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty