Healthcare Provider Details

I. General information

NPI: 1497681118
Provider Name (Legal Business Name): CHLOE SMITH MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4162 ARIZONA ST APT 6
SAN DIEGO CA
92104-1783
US

IV. Provider business mailing address

4162 ARIZONA ST APT 6
SAN DIEGO CA
92104-1783
US

V. Phone/Fax

Practice location:
  • Phone: 760-213-1540
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number20244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: