Individual
MEGAN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2178 JOHNSON AVE, SAN LUIS OBISPO, CA 93401-4535
(805) 781-4712
Mailing address
2178 JOHNSON AVE, SAN LUIS OBISPO, CA 93401-4535
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
34359
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D8206388
—
CA
Enumeration date
04/20/2017
Last updated
04/20/2017
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