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General NPI Number Information
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NPI Number | 1316773401
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Entity Type | Individual
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Provider Name | JESSICA SMITH LMSW
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Gender | Female
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Dates
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Enumeration Date | 09/13/2024
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 174 S CORONADO DR
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-6353
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Country | US
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Telephone | 520-442-2812
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1300
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City | HEREFORD
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State | AZ
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Zip | 85615-1300
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Country | US
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Telephone | 520-435-9025
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LMSW-22220
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License Number State | AZ
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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 |
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License Number State |
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