Healthcare Provider Details

I. General information

NPI: 1790690923
Provider Name (Legal Business Name): TAKIA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N LAKE AVE FL 8
PASADENA CA
91101-1849
US

IV. Provider business mailing address

829 W PALMDALE BLVD # 325
PALMDALE CA
93551-4261
US

V. Phone/Fax

Practice location:
  • Phone: 626-344-2968
  • Fax:
Mailing address:
  • Phone: 626-344-2968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4874
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4874
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number4874
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number4874
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number4874
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4874
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: