Provider Demographics
NPI:1508900929
Name:SMITH, ASHLEY JANINE (LMFT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:JANINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 626
Mailing Address - Street 2:
Mailing Address - City:KERNVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93238-0626
Mailing Address - Country:US
Mailing Address - Phone:805-391-0829
Mailing Address - Fax:
Practice Address - Street 1:1333 VAN BEURDEN DR STE 101
Practice Address - Street 2:
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-3384
Practice Address - Country:US
Practice Address - Phone:805-391-0829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT83951106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health