Provider Demographics
NPI:1619148756
Name:SMITH, JEFFREY (MA)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 N VIA ACAPULCO
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6270
Mailing Address - Country:US
Mailing Address - Phone:760-318-7893
Mailing Address - Fax:
Practice Address - Street 1:653 N VIA ACAPULCO
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6270
Practice Address - Country:US
Practice Address - Phone:760-318-7893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health