Provider Demographics
NPI:1942765730
Name:SMITH, DIANE CLARK (MFT)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:CLARK
Last Name:SMITH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 LOS VERDES DR
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-1506
Mailing Address - Country:US
Mailing Address - Phone:805-451-8383
Mailing Address - Fax:
Practice Address - Street 1:428 LOS VERDES DR
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-1506
Practice Address - Country:US
Practice Address - Phone:805-451-8383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111553106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist