Basic Information
| Provider Information | |||||||||
| NPI: | 1255697173 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH-ANDERSON | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | MFTI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2495 W MARCH LN STE 125 | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952078224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2094651080 | ||||||||
| FaxNumber: | 2094652709 | ||||||||
| Practice Location | |||||||||
| Address1: | 3737 MARCONI AVE | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164801801 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2012 | ||||||||
| LastUpdateDate: | 05/28/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 92518 | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.