Healthcare Provider Details

I. General information

NPI: 1891519476
Provider Name (Legal Business Name): ASHLEY SMITH LMFT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 VAN BEURDEN DR STE 101
LOS OSOS CA
93402-3384
US

IV. Provider business mailing address

PO BOX 626
KERNVILLE CA
93238-0626
US

V. Phone/Fax

Practice location:
  • Phone: 805-391-0829
  • Fax:
Mailing address:
  • Phone: 805-391-0829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY JANINE SMITH
Title or Position: LICENSED MARRIAGE FAMILY THERAPIST
Credential: MS, LMFT
Phone: 805-391-0829