Provider Demographics
NPI:1356366512
Name:SMITH, JANE BETH (MS, LMFT)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:BETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 CAMBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-9007
Mailing Address - Country:US
Mailing Address - Phone:530-677-2653
Mailing Address - Fax:530-677-2653
Practice Address - Street 1:3939 CAMBRIDGE RD STE 110
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-9007
Practice Address - Country:US
Practice Address - Phone:530-677-2653
Practice Address - Fax:530-677-2653
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30855106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist