Provider Demographics
NPI:1487785028
Name:SMASAL, MARK S (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:SMASAL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84771-1430
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:604 N PINION HILLS DR
Practice Address - Street 2:
Practice Address - City:DAMMERON VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84783-5180
Practice Address - Country:US
Practice Address - Phone:702-994-3890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0364103TC0700X
UT277642-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical