Provider Demographics
NPI:1821293630
Name:SMITH, MARILEE ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARILEE
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 25TH AVE
Mailing Address - Street 2:#200
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-4945
Mailing Address - Country:US
Mailing Address - Phone:970-351-6688
Mailing Address - Fax:970-351-6687
Practice Address - Street 1:1750 25TH AVE
Practice Address - Street 2:#200
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4945
Practice Address - Country:US
Practice Address - Phone:970-351-6688
Practice Address - Fax:970-351-6687
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1530103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical