MEDICARE: EMILY MICHELLE SMOLLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	150730	CA

General Provider Information

NPI Number	:	1356783435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY MICHELLE SMOLLER

Provider Business Mailing Address
First Line	:	2829 WATT AVE STE 200
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-6245
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2829 WATT AVE STE 200
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-6245
Country	:	US
Telephone Number	:	916-418-0828
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2013
Last Update Date	:	02/14/2025

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