Provider Demographics
NPI:1053548123
Name:SMITH, STEVEN E (MFT)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:E
Last Name:SMITH
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 E CAMPBELL AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-2013
Mailing Address - Country:US
Mailing Address - Phone:408-910-4257
Mailing Address - Fax:408-796-7575
Practice Address - Street 1:409 E CAMPBELL AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2013
Practice Address - Country:US
Practice Address - Phone:408-910-4257
Practice Address - Fax:408-796-7575
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46347106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist