Provider Demographics
NPI:1861458093
Name:SMETS, ANTON C (PHD PSYD)
Entity Type:Individual
Prefix:
First Name:ANTON
Middle Name:C
Last Name:SMETS
Suffix:
Gender:M
Credentials:PHD PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N FARWELL ST STE 204
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-3767
Mailing Address - Country:US
Mailing Address - Phone:715-514-4600
Mailing Address - Fax:715-514-4008
Practice Address - Street 1:101 N FARWELL ST STE 204
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-3767
Practice Address - Country:US
Practice Address - Phone:715-514-4600
Practice Address - Fax:715-514-4008
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI845057103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI23941OtherSECURITY HEALTH PLAN
MN6103256OtherMEDICA UBH UHC
MN8H005SMOtherBCBS MN
MNHP18916OtherHEALTH PARTNERS
WI39019900Medicaid
MN637871026351OtherPREFERRED ONE
WI23941OtherSECURITY HEALTH PLAN
WI000284659Medicare ID - Type Unspecified