Provider Demographics
NPI:1710993399
Name:SMITH, THOMAS ALBERT (MFT)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ALBERT
Last Name:SMITH
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 RIO VISTA DR
Mailing Address - Street 2:#10
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-3266
Mailing Address - Country:US
Mailing Address - Phone:530-885-8310
Mailing Address - Fax:530-885-8310
Practice Address - Street 1:331 RIO VISTA DR
Practice Address - Street 2:#10
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-3266
Practice Address - Country:US
Practice Address - Phone:530-885-8310
Practice Address - Fax:530-885-8310
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 17105106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist