Individual
DR. SUSANNAH SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
747 PACIFIC ST., 421, TELLURIDE, CO 81435
(970) 728-5234
Mailing address
PO BOX 3258, TELLURIDE, CO 81435-3258
(970) 728-5234
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1830
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02680874
—
CO
Enumeration date
01/03/2007
Last updated
07/14/2011
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