Provider Demographics
NPI:1073810727
Name:SMALLEY, KURT VINCENT
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:VINCENT
Last Name:SMALLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 E HALEY ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2330
Mailing Address - Country:US
Mailing Address - Phone:805-904-3881
Mailing Address - Fax:805-963-8849
Practice Address - Street 1:133 E HALEY ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2330
Practice Address - Country:US
Practice Address - Phone:805-904-3881
Practice Address - Fax:805-963-8849
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)