MEDICARE: EVELYNN SMITH-HERMAN MA MFT

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
1	106H00000X	Marriage & Family Therapist	31989	CA

General Provider Information

NPI Number	:	1265414361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVELYNN SMITH-HERMAN MA MFT

Provider Business Mailing Address
First Line	:	PO BOX 50418
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93150-0418
Country	:	US
Telephone Number	:	805-969-5500
Fax Number	:	805-969-6130

Provider Business Practice Location Address
First Line	:	686 EL RANCHO RD
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93108-1842
Country	:	US
Telephone Number	:	805-969-5500
Fax Number	:	805-969-6130

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	07/08/2007

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