Provider Demographics
NPI:1871228270
Name:CLAYTON SMITH, RACHELLE
Entity type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:
Last Name:CLAYTON SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9222
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91309-0222
Mailing Address - Country:US
Mailing Address - Phone:310-529-1741
Mailing Address - Fax:
Practice Address - Street 1:5700 HANNUM AVE STE 150
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6535
Practice Address - Country:US
Practice Address - Phone:424-351-8535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT131581106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty