Provider Demographics
NPI:1053578310
Name:SMITH, MICHAEL H (PHD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:H
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3640 GRAND AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2023
Mailing Address - Country:US
Mailing Address - Phone:510-832-8500
Mailing Address - Fax:510-832-8505
Practice Address - Street 1:3640 GRAND AVE
Practice Address - Street 2:STE 204
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2023
Practice Address - Country:US
Practice Address - Phone:510-832-8500
Practice Address - Fax:510-832-8505
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT14953106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist