Provider Demographics
NPI:1437965456
Name:SMITH, LESLIE LOUISE MARY MARGARET
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:LOUISE MARY MARGARET
Last Name: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 1:276 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-5520
Mailing Address - Country:US
Mailing Address - Phone:661-706-7476
Mailing Address - Fax:
Practice Address - Street 1:276 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-5520
Practice Address - Country:US
Practice Address - Phone:661-706-7476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA145194106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist