Provider Demographics
NPI:1134214463
Name:SMITH, DANIEL KEITH (MFT)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:KEITH
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 1:1101 STANDIFORD AVE
Mailing Address - Street 2:SUITE A-7
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-0981
Mailing Address - Country:US
Mailing Address - Phone:209-522-2285
Mailing Address - Fax:
Practice Address - Street 1:1101 STANDIFORD AVE
Practice Address - Street 2:SUITE A-7
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-0981
Practice Address - Country:US
Practice Address - Phone:209-522-2285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34288106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist