Provider Demographics
NPI:1568887180
Name:SMITH, JAYNE ERIN (PHD, LPCC)
Entity Type:Individual
Prefix:DR
First Name:JAYNE
Middle Name:ERIN
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD, LPCC
Other - Prefix:
Other - First Name:JAYNE
Other - Middle Name:ERIN SMITH
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LPCC
Mailing Address - Street 1:1130 FREMONT BLVD STE 105-135
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:CA
Mailing Address - Zip Code:93955-5700
Mailing Address - Country:US
Mailing Address - Phone:831-242-1987
Mailing Address - Fax:
Practice Address - Street 1:1130 FREMONT BLVD STE 105-135
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955-5700
Practice Address - Country:US
Practice Address - Phone:831-242-1987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-19
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA495101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional