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General NPI Number Information
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NPI Number | 1346720562
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Entity Type | Organization
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Legal Business Name | MINDSMITH, A PSYCHOLOGICAL PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 08/16/2018
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Last Update Date | 08/16/2018
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Provider Practice Location Address
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Address Line | 2330 MAIN ST STE D
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City | RAMONA
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State | CA
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Zip | 92065-2539
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Country | US
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Telephone | 619-376-7076
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Fax | 619-303-4270
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Provider Business Mailing Address
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Address Line | 5575 LAKE PARK WAY STE 100
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City | LA MESA
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State | CA
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Zip | 91942-1669
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Country | US
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Telephone | 619-378-7076
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Fax | 619-303-4270
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. JENNIFER ANE MILLER
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Credential | PSYD
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Telephone | 619-378-7076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY17908
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License Number State | CA
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