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General NPI Number Information
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NPI Number | 1629137740
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Entity Type | Individual
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Provider Name | HEATHER LYNN SMITH MA
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Gender | Female
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4220 KINDRED CT
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City | MODESTO
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State | CA
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Zip | 95356-1870
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Country | US
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Telephone | 209-521-7254
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Fax | 209-575-4444
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Provider Business Mailing Address
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Address Line | PO BOX 578100
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City | MODESTO
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State | CA
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Zip | 95357-8100
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Country | US
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Telephone | 209-883-2947
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Fax | 209-883-9392
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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 | MFC30960
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License Number State | CA
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