MEDICARE: JENNIFER CHRISTA SMITH

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

General Provider Information

NPI Number	:	1811735947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER CHRISTA SMITH

Provider Business Mailing Address
First Line	:	3150 PIO PICO DR
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008-1951
Country	:	US
Telephone Number	:	760-500-3325
Fax Number	:

Provider Business Practice Location Address
First Line	:	16959 BERNARDO CENTER DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-2553
Country	:	US
Telephone Number	:	760-500-3325
Fax Number	:

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

Provider Enumeration Date	:	07/15/2024
Last Update Date	:	07/15/2024

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