Shynelle A. Smith, MFT

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

AMFT124110 Issued in CA

Practice address

1904 Richland Ave
Ceres, CA 95307-4562

Phone

(209) 552-2862

NPI assigned

Sep 3, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Rise- Reaching Independence Through Support & Empowerment

  • Professional Counselor
  • Stockton, CA
  • NPI 1558224527
  NPD Authorized official
• Victor Community Support Services, Inc.

  • Adolescent and Children Mental Health Clinic/Center
  • Stockton, CA
  • NPI 1932251980
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1409702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704153600000",
    "number": "1124428594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1904 RICHLAND AVE",
            "city": "CERES",
            "state": "CA",
            "postal_code": "953074562",
            "telephone_number": "209-552-2862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1904 RICHLAND AVE",
            "city": "CERES",
            "state": "CA",
            "postal_code": "953074562",
            "telephone_number": "209-552-2862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "SHYNELLE",
        "middle_name": "A.",
        "credential": "MFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-03",
        "last_updated": "2024-01-02",
        "certification_date": "2024-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CA",
            "license": "AMFT124110",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittny Sisk
• Derek Smernes
• Justin Smernes
• Elisabeth Ann Smith, ACSW
• Regina Chinika Smith
• Bill W Sneed Jr., MS
• Sonia Arevalo DMD Inc
• Isac Soriano Jr., BA, SUDRC
• Marie Soriano
• Amanda Christine Sorrels

• Professional Counselor in Ceres, CA
• Providers in Ceres, CA by specialty
• Professional Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.