Provider Demographics
NPI:1861006181
Name:SMALLY, ROY F JR (AMFT)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:F
Last Name:SMALLY
Suffix:JR
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2165 LARKSPUR LN
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0600
Mailing Address - Country:US
Mailing Address - Phone:530-226-7419
Mailing Address - Fax:530-224-9433
Practice Address - Street 1:1620 PENNSYLVANIA AVE STE C
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3509
Practice Address - Country:US
Practice Address - Phone:707-439-4039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99046106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist