Healthcare Provider Details

I. General information

NPI: 1740158526
Provider Name (Legal Business Name): PAUL SMITH AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 SUNSET LN STE 110
ANTIOCH CA
94509-6134
US

IV. Provider business mailing address

424 2ND ST
OAKLAND CA
94607-3815
US

V. Phone/Fax

Practice location:
  • Phone: 510-233-7555
  • Fax:
Mailing address:
  • Phone: 510-835-2777
  • Fax: 510-835-0164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT156562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: