Provider Demographics
NPI:1750929964
Name:SMITH, DARCY JORDAN (MT-BC)
Entity type:Individual
Prefix:
First Name:DARCY
Middle Name:JORDAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 COUNTRY CLUB GATE CTR STE 7
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-5014
Mailing Address - Country:US
Mailing Address - Phone:831-204-6554
Mailing Address - Fax:
Practice Address - Street 1:220 COUNTRY CLUB GATE CTR STE 7
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-5014
Practice Address - Country:US
Practice Address - Phone:831-204-6554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty