Healthcare Provider Details

I. General information

NPI: 1306205745
Provider Name (Legal Business Name): ALLISON JAYNE SMITH LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2016
Last Update Date: 02/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 JOURNEY STE 210
ALISO VIEJO CA
92656-5332
US

IV. Provider business mailing address

5 JOURNEY STE 210
ALISO VIEJO CA
92656-5332
US

V. Phone/Fax

Practice location:
  • Phone: 949-305-7122
  • Fax:
Mailing address:
  • Phone: 949-305-7122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number90288
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: