Provider Demographics
NPI:1932316437
Name:SMITH, KIM A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:A
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 1:900 POTOMAC ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-6716
Mailing Address - Country:US
Mailing Address - Phone:303-363-5653
Mailing Address - Fax:303-360-8208
Practice Address - Street 1:900 POTOMAC ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-6716
Practice Address - Country:US
Practice Address - Phone:303-363-5653
Practice Address - Fax:303-360-8208
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2829103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)