Healthcare Provider Details

I. General information

NPI: 1952071367
Provider Name (Legal Business Name): JALA LATRICE NICOLE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7236 S CENTRAL AVE
PHOENIX AZ
85042-5425
US

IV. Provider business mailing address

18899 N THOMPSON PEAK PKWY STE 100
SCOTTSDALE AZ
85255-6335
US

V. Phone/Fax

Practice location:
  • Phone: 602-240-3074
  • Fax:
Mailing address:
  • Phone: 480-999-6199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: