Provider Demographics
NPI:1679680334
Name:SMITH, LAWRENCE WESLEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:WESLEY
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 1:701 5TH AVE STE 4200
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-7047
Mailing Address - Country:US
Mailing Address - Phone:206-447-1404
Mailing Address - Fax:866-571-9312
Practice Address - Street 1:701 5TH AVE STE 4200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-7047
Practice Address - Country:US
Practice Address - Phone:206-447-1404
Practice Address - Fax:866-571-9312
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1670103TC0700X
WAPY00001670103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8801323Medicare ID - Type Unspecified