Provider Demographics
NPI:1104946953
Name:SMITH, BETH ANN (MA)
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2043 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-4429
Mailing Address - Country:US
Mailing Address - Phone:303-444-1558
Mailing Address - Fax:
Practice Address - Street 1:2043 PEARL ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-4429
Practice Address - Country:US
Practice Address - Phone:303-444-1558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health