Provider Demographics
NPI:1952610529
Name:SMITH, BRETT ASHLEY (MFT, CCHT)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:ASHLEY
Last Name:SMITH
Suffix:
Gender:M
Credentials:MFT, CCHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4470 WEST SUNSET BLVD
Mailing Address - Street 2:STE 107, PMB93982
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-9009
Mailing Address - Country:US
Mailing Address - Phone:916-717-2223
Mailing Address - Fax:
Practice Address - Street 1:8780 MADISON AVE APT 138
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628
Practice Address - Country:US
Practice Address - Phone:916-717-2223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46410106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC46410OtherMARRIAGE AND FAMILY COUNSELING