MEDICARE: MRS. RHONDA SHAW SMILLIE LPCC

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	0747	MS
2	101YP2500X	Professional Counselor	4170	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1203	OTHER	MS	LPC/ MENTAL HEALTH

General Provider Information

NPI Number	:	1962687798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RHONDA SHAW SMILLIE LPCC

Provider Business Mailing Address
First Line	:	121 N LUCIA AVE
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3219
Country	:	US
Telephone Number	:	662-801-4947
Fax Number	:	662-236-3071

Provider Business Practice Location Address
First Line	:	121 N LUCIA AVE
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3219
Country	:	US
Telephone Number	:	662-801-4947
Fax Number	:	662-236-3071

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

Provider Enumeration Date	:	12/28/2007
Last Update Date	:	09/20/2023

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