Provider Demographics
NPI:1912495987
Name:SMITH, KARLIE
Entity Type:Individual
Prefix:
First Name:KARLIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5063 WATERVIEW WAY UNIT 206
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-7875
Mailing Address - Country:US
Mailing Address - Phone:208-270-9816
Mailing Address - Fax:
Practice Address - Street 1:5063 WATERVIEW WAY UNIT 206
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-7875
Practice Address - Country:US
Practice Address - Phone:208-270-9816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty