Provider Demographics
NPI:1194557421
Name:SMITH, JENTRE FAITH
Entity type:Individual
Prefix:
First Name:JENTRE
Middle Name:FAITH
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 1:14478 ROAD T
Mailing Address - Street 2:
Mailing Address - City:KISMET
Mailing Address - State:KS
Mailing Address - Zip Code:67859-5999
Mailing Address - Country:US
Mailing Address - Phone:620-417-5756
Mailing Address - Fax:
Practice Address - Street 1:6214 24TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3319
Practice Address - Country:US
Practice Address - Phone:866-222-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician