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NPI Code Detail

MEDICARE: ANDREW SMITH

MEDICARE: ANDREW SMITH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor
2101YA0400XAddiction (Substance Use Disorder) Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063773612
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW SMITH
Provider Business Mailing Address
First Line : 3648 EL PORTAL DR
Second Line :
City : REDDING
State : CA
Zip : 96002-3133
Country : US
Telephone Number : 530-722-1114
Fax Number :
Provider Business Practice Location Address
First Line : 3648 EL PORTAL DR
Second Line :
City : REDDING
State : CA
Zip : 96002-3133
Country : US
Telephone Number : 530-722-1114
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2012
Last Update Date : 04/29/2024

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Directions to “ ANDREW SMITH ” Practice Location

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