Provider Demographics
NPI:1821616053
Name:SMITH, ALEISA M (LPCC)
Entity Type:Individual
Prefix:
First Name:ALEISA
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 PASEO DEL PUEBLO SUR UNIT 204
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-5974
Mailing Address - Country:US
Mailing Address - Phone:575-425-5485
Mailing Address - Fax:
Practice Address - Street 1:208 PASEO DEL PUEBLO SUR UNIT 204
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-5974
Practice Address - Country:US
Practice Address - Phone:575-425-5485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM101YM0800X
NMCTB-2022-0979101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM73725773Medicaid