Provider Demographics
NPI:1265520431
Name:SINCLAIR-SMITH, KAREN (PHD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:SINCLAIR-SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E CHEYENNE MOUNTAIN BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3700
Mailing Address - Country:US
Mailing Address - Phone:719-510-8389
Mailing Address - Fax:
Practice Address - Street 1:225 E CHEYENNE MOUNTAIN BLVD STE 205
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906
Practice Address - Country:US
Practice Address - Phone:719-510-8389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007511103TC0700X
IL071.006541103TC0700X
CO2939103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S14326Medicare UPIN
CO804789Medicare ID - Type Unspecified