Provider Demographics
NPI:1750175592
Name:SMITH, LELAND (PLPC)
Entity type:Individual
Prefix:
First Name:LELAND
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4133 NAVAJO RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-6539
Mailing Address - Country:US
Mailing Address - Phone:601-720-3938
Mailing Address - Fax:
Practice Address - Street 1:4133 NAVAJO RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-6539
Practice Address - Country:US
Practice Address - Phone:601-720-3938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health