Provider Demographics
NPI:1467842401
Name:P. JEAN SMITH LMFT
Entity Type:Organization
Organization Name:P. JEAN SMITH LMFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIPA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:SOLE PROPRIETOR
Authorized Official - Phone:559-859-1911
Mailing Address - Street 1:204 N FLORAL ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-4957
Mailing Address - Country:US
Mailing Address - Phone:559-406-9761
Mailing Address - Fax:484-906-1676
Practice Address - Street 1:204 N FLORAL ST
Practice Address - Street 2:SUITE A
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4957
Practice Address - Country:US
Practice Address - Phone:559-406-9761
Practice Address - Fax:484-906-1676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC45288251S00000X
CA7251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12575812OtherCAQH