Provider Demographics
NPI:1811199276
Name:SMITH, LEESA LANELLE (MS)
Entity Type:Individual
Prefix:
First Name:LEESA
Middle Name:LANELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13851 OAK HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:MOSS POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39562-9165
Mailing Address - Country:US
Mailing Address - Phone:228-219-4343
Mailing Address - Fax:
Practice Address - Street 1:13851 OAK HAVEN DR
Practice Address - Street 2:
Practice Address - City:MOSS POINT
Practice Address - State:MS
Practice Address - Zip Code:39562-9165
Practice Address - Country:US
Practice Address - Phone:228-219-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor