Active NPI
Chris Smith, MDIV LMFT
- Marriage & Family Therapist
- Port Washington, WI
National Provider Identifier
1407022692
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 68124
- Practice address
- 121 W Main St
Port Washington, WI 53074-0994 - Phone
- (262) 284-8200
- Fax
- (262) 284-8104
- NPI assigned
- May 7, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 68124 | WI | Primary |
Addresses
Primary practice location
121 W Main St
Port Washington, WI 53074-0994
Mailing address
121 W Main St
Port Washington, WI 53074-0994
Phone (262) 284-8200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40981600 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 68124 | WI | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210118400000",
"number": "1407022692",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "121 W MAIN ST",
"city": "PORT WASHINGTON",
"state": "WI",
"postal_code": "530740994",
"telephone_number": "262-284-8200",
"fax_number": "262-284-8104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "121 W MAIN ST",
"city": "PORT WASHINGTON",
"state": "WI",
"postal_code": "530740994",
"telephone_number": "262-284-8200",
"fax_number": "262-284-8104"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "CHRIS",
"credential": "MDIV LMFT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-05-07",
"last_updated": "2008-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "WI",
"license": "68124",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40981600",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Washington, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.