Provider Demographics
NPI:1366432221
Name:SMITH, SHIRLEY HELEN (LMFT)
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:HELEN
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 1:4700 SPRING ST
Mailing Address - Street 2:STE 306
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-5263
Mailing Address - Country:US
Mailing Address - Phone:619-697-0358
Mailing Address - Fax:619-466-7284
Practice Address - Street 1:4700 SPRING ST
Practice Address - Street 2:STE 306
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-5263
Practice Address - Country:US
Practice Address - Phone:619-697-0358
Practice Address - Fax:619-466-7284
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM17104106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist