Provider Demographics
NPI:1982792057
Name:SMOOT, FREDERICK L (LMFT, PH D)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:L
Last Name:SMOOT
Suffix:
Gender:M
Credentials:LMFT, PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30290 RAVENSWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-4808
Mailing Address - Country:US
Mailing Address - Phone:404-695-5266
Mailing Address - Fax:
Practice Address - Street 1:30290 RAVENSWOOD CIR
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-4808
Practice Address - Country:US
Practice Address - Phone:404-695-5266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA12959101YM0800X
CA12959101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health