Healthcare Provider Details

I. General information

NPI: 1932043551
Provider Name (Legal Business Name): JESSICA SMITH
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 10/23/2026
Certification Date: 10/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 PARK AVE
SOQUEL CA
95073-2831
US

IV. Provider business mailing address

350 SANSOME ST
SAN FRANCISCO CA
94104-1304
US

V. Phone/Fax

Practice location:
  • Phone: 831-423-9444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: