Provider Demographics
NPI:1295295509
Name:SMITH, STEPHEN DOUGLAS (CALIFORNIA LMFT)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:DOUGLAS
Last Name:SMITH
Suffix:
Gender:M
Credentials:CALIFORNIA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2591 PARKCREST WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-7140
Mailing Address - Country:US
Mailing Address - Phone:916-758-7997
Mailing Address - Fax:
Practice Address - Street 1:2591 PARKCREST WAY
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-7140
Practice Address - Country:US
Practice Address - Phone:916-758-7997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19775101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health