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General NPI Number Information
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NPI Number | 1629271325
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Entity Type | Individual
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Provider Name | JACQUELINE ALICE SMITH-RATLIFF LMFT
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Gender | Female
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Dates
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Enumeration Date | 06/08/2007
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 7273 MURRAY DR STE 12
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City | STOCKTON
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State | CA
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Zip | 95210-3390
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Country | US
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Telephone | 510-816-1265
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Fax | 800-858-8673
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Provider Business Mailing Address
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Address Line | PO BOX 3665
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City | SAN LEANDRO
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State | CA
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Zip | 94578-0665
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Country | US
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Telephone | 510-258-8869
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Fax | 800-858-8673
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMF47159
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 48253
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License Number State | CA
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