Provider Demographics
NPI:1386935427
Name:SMALLWOOD, CHRISTOPHER JAMES (PHD, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JAMES
Last Name:SMALLWOOD
Suffix:
Gender:M
Credentials:PHD, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12600 HILL COUNTRY BLVD STE R130-302
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6723
Mailing Address - Country:US
Mailing Address - Phone:512-222-7105
Mailing Address - Fax:
Practice Address - Street 1:150 E PALMETTO PARK RD STE 800
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-4833
Practice Address - Country:US
Practice Address - Phone:561-203-9707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-24
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10682363LP0808X, 363LP0808X, 363LP0808X
OR201708851NP-PP363LP0808X, 363LP0808X
NH068737-23363LP0808X
RIAPRN01741363LP0808X
WAAP60801933363LP0808X
NH0000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ411252Medicaid