Organization
JACQULINE SMYTHE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JACQULINE GAIL SMYTHE (MFT)
(707) 349-2586
Entity
Organization
Contact information
Practice address
55 1ST ST # 302, LAKEPORT, CA 95453-4839
(707) 349-2586
(707) 263-4662
Mailing address
3542 CRESTWOOD DR, KELSEYVILLE, CA 95451-8602
(707) 349-2586
(707) 263-4662
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
MFT43231
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MFT 43231
BLUE CROSS
—
Enumeration date
11/04/2010
Last updated
11/04/2010
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