Provider Demographics
NPI:1003119967
Name:SMITH, LEIGH ANN (LPC)
Entity Type:Individual
Prefix:MS
First Name:LEIGH ANN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 8TH AVE
Mailing Address - Street 2:BOX 16
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-1352
Mailing Address - Country:US
Mailing Address - Phone:817-926-1148
Mailing Address - Fax:
Practice Address - Street 1:1810 8TH AVE
Practice Address - Street 2:BOX 16
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1352
Practice Address - Country:US
Practice Address - Phone:817-926-1148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19230102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst