Healthcare Provider Details

I. General information

NPI: 1235790197
Provider Name (Legal Business Name): MIKAYLA A SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13950 MILTON AVE STE 306
WESTMINSTER CA
92683-2939
US

IV. Provider business mailing address

13950 MILTON AVE
WESTMINSTER CA
92683-2900
US

V. Phone/Fax

Practice location:
  • Phone: 714-793-1290
  • Fax:
Mailing address:
  • Phone: 714-793-1290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC18474
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: