Provider Demographics
NPI:1649745837
Name:SMITH, COURTNEY JEAN (MSW)
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:JEAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:CJ
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:257 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-2539
Mailing Address - Country:US
Mailing Address - Phone:916-316-4211
Mailing Address - Fax:
Practice Address - Street 1:257 CEDAR ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-2539
Practice Address - Country:US
Practice Address - Phone:916-316-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW77347101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health