Provider Demographics
NPI:1629035704
Name:SMITH, RHONDA H (MFT)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:H
Last Name:SMITH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23110 ATLANTIC CIR STE F
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-5920
Mailing Address - Country:US
Mailing Address - Phone:951-243-6455
Mailing Address - Fax:951-243-0207
Practice Address - Street 1:23110 ATLANTIC CIR STE F
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-5920
Practice Address - Country:US
Practice Address - Phone:951-243-6455
Practice Address - Fax:951-243-0207
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2018-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36253106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFT36253OtherBOARD OF BEHAVIORAL SCIENCES LICENSE