Healthcare Provider Details

I. General information

NPI: 1275812695
Provider Name (Legal Business Name): JARED C SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JARED CHRISTOPHER SMITH

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 NIBLICK ROAD
PASO ROBLES CA
93446
US

IV. Provider business mailing address

800 NIBLICK ROAD
PASO ROBLES CA
93446
US

V. Phone/Fax

Practice location:
  • Phone: 805-769-1000
  • Fax: 805-503-6499
Mailing address:
  • Phone: 805-769-1000
  • Fax: 805-503-6499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number90989
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: