Basic Information
| Provider Information | |||||||||
| NPI: | 1477803930 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | V. JASMIN | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | SMITH | ||||||||
| OtherFirstName: | VILKA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | MA, LMFT | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 921 E COMPTON BLVD | ||||||||
| Address2: | |||||||||
| City: | COMPTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902213303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106686800 | ||||||||
| FaxNumber: | 3102230694 | ||||||||
| Practice Location | |||||||||
| Address1: | 921 E COMPTON BLVD | ||||||||
| Address2: | |||||||||
| City: | COMPTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106686800 | ||||||||
| FaxNumber: | 3102230694 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2012 | ||||||||
| LastUpdateDate: | 01/08/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | LMFT107660 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.