Provider Demographics
NPI:1750315230
Name:SMITH, GARLAND DALE (MFT)
Entity Type:Individual
Prefix:MR
First Name:GARLAND
Middle Name:DALE
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 1:7171 BOWLING DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2034
Mailing Address - Country:US
Mailing Address - Phone:916-875-0729
Mailing Address - Fax:916-875-1086
Practice Address - Street 1:7171 BOWLING DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2034
Practice Address - Country:US
Practice Address - Phone:916-875-0729
Practice Address - Fax:916-875-1086
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38289106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist