Provider Demographics
NPI:1336588128
Name:SMITH, PHILLIPA JEAN (LMFT LPCC)
Entity Type:Individual
Prefix:MS
First Name:PHILLIPA
Middle Name:JEAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMFT LPCC
Other - Prefix:MS
Other - First Name:P.
Other - Middle Name:JEAN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT LPCC
Mailing Address - Street 1:204 N FLORAL ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-4957
Mailing Address - Country:US
Mailing Address - Phone:559-643-6620
Mailing Address - Fax:
Practice Address - Street 1:204 N FLORAL ST
Practice Address - Street 2:SUITE A
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4957
Practice Address - Country:US
Practice Address - Phone:559-643-6620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPC 7101YP2500X
CAMFC 45288106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC45288OtherBBS LICENSE NUMBER
CALPC 7OtherBBS LICENSE NUMBER