Basic Information
Provider Information
NPI: 1992784771
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: EATOUGH-SMITH
FirstName: STEVEN
MiddleName: G
NamePrefix:  
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX A D
Address2:  
City: YUBA CITY
State: CA
PostalCode: 959921396
CountryCode: US
TelephoneNumber: 5307513769
FaxNumber: 5307511237
Practice Location
Address1: 2800 LINCOLN BLVD
Address2:  
City: OROVILLE
State: CA
PostalCode: 959665961
CountryCode: US
TelephoneNumber: 5305347500
FaxNumber: 5305340210
Other Information
ProviderEnumerationDate: 01/11/2006
LastUpdateDate: 07/13/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X17799CAY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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