Provider Information for 1255615480
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RAYLAND L SMITH LPC, BC-TMH
Sex: Male
NPI: 1255615480
Last Updated: 2023-11-30
Certification Date: 2023-11-30
Certification Date: 2023-11-30
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1255615480 | ||||||||
| Enumeration Date | 2011-10-06 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 24600 COUNTY ROAD 21 LA JUNTA, CO 81050-9765 United States Phone: 719-469-2670 | Fax: | ||||||||
| Primary Practice Address | 24600 COUNTY ROAD 21 LA JUNTA, CO 81050-9765 United States Phone: 719-469-2670 | Fax: | ||||||||
| Secondary Practice Address(es) | 317 W 3RD ST STE 203 510 CARSON AVE | ||||||||
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