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General NPI Number Information
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NPI Number | 1306619036
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Entity Type | Individual
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Provider Name | PRENTIS SMITH
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Gender | Male
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Dates
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Enumeration Date | 11/03/2023
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 840 N AVENUE 66
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City | LOS ANGELES
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State | CA
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Zip | 90042-1508
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Country | US
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Telephone | 626-517-2368
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Fax |
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Provider Business Mailing Address
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Address Line | 1414 N RIVERSIDE AVE APT 107
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City | RIALTO
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State | CA
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Zip | 92376-8065
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Country | US
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Telephone | 626-606-7116
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 118862
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 118862
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License Number State | CA
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