Provider Demographics
NPI:1851789093
Name:SMITH, JANIS ALEXA (LMFT)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:ALEXA
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JANIS
Other - Middle Name:ALEXA
Other - Last Name:HODGSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2130 E 4TH ST STE 150
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3842
Mailing Address - Country:US
Mailing Address - Phone:714-558-3807
Mailing Address - Fax:
Practice Address - Street 1:2130 E 4TH ST STE 150
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3842
Practice Address - Country:US
Practice Address - Phone:714-558-3807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA131940106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
96-4079133OtherTAXONOMY