Provider Demographics
NPI:1124709373
Name:SMITH, TERRANCE (MCPSS)
Entity type:Individual
Prefix:
First Name:TERRANCE
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:MCPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 N PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93728-2434
Mailing Address - Country:US
Mailing Address - Phone:559-899-0888
Mailing Address - Fax:
Practice Address - Street 1:1040 N PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-2434
Practice Address - Country:US
Practice Address - Phone:559-899-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-SHVCKY172V00000X, 175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172V00000XOther Service ProvidersCommunity Health Worker