Healthcare Provider Details

I. General information

NPI: 1154040889
Provider Name (Legal Business Name): BRIANA SMITH, LMFT INDIVIDUAL & FAMILY THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 PARK NEWPORT APT 305
NEWPORT BEACH CA
92660-5024
US

IV. Provider business mailing address

1220 PARK NEWPORT APT 305
NEWPORT BEACH CA
92660-5024
US

V. Phone/Fax

Practice location:
  • Phone: 310-962-0432
  • Fax:
Mailing address:
  • Phone: 310-962-0432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRIANA SMITH
Title or Position: OWNER
Credential:
Phone: 310-962-0432