Healthcare Provider Details

I. General information

NPI: 1508599895
Provider Name (Legal Business Name): MARISSA M SMIT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 OLYMPIC BLVD STE 240
WALNUT CREEK CA
94596-5079
US

IV. Provider business mailing address

1901 OLYMPIC BLVD STE 240
WALNUT CREEK CA
94596-5079
US

V. Phone/Fax

Practice location:
  • Phone: 925-489-2658
  • Fax:
Mailing address:
  • Phone: 559-288-2558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number140618
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: