Provider Demographics
NPI:1811310741
Name:SMITH, JASMYNN (MA)
Entity type:Individual
Prefix:
First Name:JASMYNN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 TORRANCE BLVD FL 3
Mailing Address - Street 2:PMB 345
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4857
Mailing Address - Country:US
Mailing Address - Phone:424-265-9255
Mailing Address - Fax:
Practice Address - Street 1:3655 TORRANCE BLVD FL 3
Practice Address - Street 2:PMB 345
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4857
Practice Address - Country:US
Practice Address - Phone:424-265-9255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2021-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101235106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist