Healthcare Provider Details

I. General information

NPI: 1750891156
Provider Name (Legal Business Name): EMMITT YVES SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 HELLING WAY
NEVADA CITY CA
95959-8619
US

IV. Provider business mailing address

140 LITTON DR STE 204
GRASS VALLEY CA
95945-5079
US

V. Phone/Fax

Practice location:
  • Phone: 916-787-8860
  • Fax:
Mailing address:
  • Phone: 530-913-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: