Provider Demographics
NPI:1104312370
Name:SMITH, DEBRA KAY (LMFT)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:KAY
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33726 CHRISCO ST
Mailing Address - Street 2:
Mailing Address - City:AGUA DULCE
Mailing Address - State:CA
Mailing Address - Zip Code:91390-5051
Mailing Address - Country:US
Mailing Address - Phone:661-998-9968
Mailing Address - Fax:
Practice Address - Street 1:33726 CHRISCO ST
Practice Address - Street 2:
Practice Address - City:AGUA DULCE
Practice Address - State:CA
Practice Address - Zip Code:91390-5051
Practice Address - Country:US
Practice Address - Phone:661-998-9968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107247106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist