MEDICARE: RANDALL 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	101YM0800X	Mental Health Counselor	96318	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	96318	OTHER	CA	BBS

General Provider Information

NPI Number	:	1841736477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDALL SMITH

Provider Business Mailing Address
First Line	:	859 HAUSER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4725
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	859 HAUSER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4725
Country	:	US
Telephone Number	:	323-356-4552
Fax Number	:

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

Provider Enumeration Date	:	01/06/2017
Last Update Date	:	04/11/2023

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Directions to “ RANDALL SMITH ” Practice Location

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