Provider Demographics
NPI:1659851731
Name:SMITH, SHANA J (LMFT)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4034 S DEMAREE ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-9476
Mailing Address - Country:US
Mailing Address - Phone:559-738-0700
Mailing Address - Fax:559-738-0710
Practice Address - Street 1:4034 S DEMAREE ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-9476
Practice Address - Country:US
Practice Address - Phone:559-738-0700
Practice Address - Fax:559-738-0710
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT106562101YM0800X
CA106562106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA106562OtherBOARD OF BEHAVIORAL SCIENCES