Provider Demographics
NPI:1871832659
Name:SMITH, SHANDA YUVETTE (PHD, LMFT)
Entity type:Individual
Prefix:DR
First Name:SHANDA
Middle Name:YUVETTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 S WEIR CANYON RD STE 157
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1800
Mailing Address - Country:US
Mailing Address - Phone:951-343-7193
Mailing Address - Fax:
Practice Address - Street 1:11801 PIERCE ST STE 200
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-4400
Practice Address - Country:US
Practice Address - Phone:951-343-7193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-13
Last Update Date:2023-04-11
Deactivation Date:2014-01-23
Deactivation Code:
Reactivation Date:2016-12-15
Provider Licenses
StateLicense IDTaxonomies
CAMFC 45486106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist