Provider Demographics
NPI:1982813952
Name:DOMELSMITH, DAVID EUGENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EUGENE
Last Name:DOMELSMITH
Suffix:
Gender:M
Credentials:PHD
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Other - Credentials:
Mailing Address - Street 1:CARL R. DARNALL ARMY MEDICAL CENTER, 36000 DARNALL LOOP
Mailing Address - Street 2:CHILD AND ADOLESCENT PSYCHIATRY, BOX 46
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544
Mailing Address - Country:US
Mailing Address - Phone:254-288-8731
Mailing Address - Fax:254-286-7629
Practice Address - Street 1:36000 DARNALL LOOP
Practice Address - Street 2:CRDAMC, BOX 46, CHILD AND ADOLESCENT PSYCHIATRY
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-5095
Practice Address - Country:US
Practice Address - Phone:254-288-8731
Practice Address - Fax:254-286-7629
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX24165103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent