MEDICARE: DR. KATHERINE WILSON SMITH PSYD

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		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01536011	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1467859017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE WILSON SMITH PSYD

Provider Business Mailing Address
First Line	:	420 S BEVERLY DR # 100-17B
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-4426
Country	:	US
Telephone Number	:	323-943-1978
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 S BEVERLY DR # 100-17B
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212
Country	:	US
Telephone Number	:	323-943-1978
Fax Number	:

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

Provider Enumeration Date	:	11/25/2014
Last Update Date	:	03/10/2026

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