Provider Demographics
NPI:1750845533
Name:SMITH, DAVID LEONARD (LMFT, LPCC, PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LEONARD
Last Name:SMITH
Suffix:
Gender:M
Credentials:LMFT, LPCC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 172
Mailing Address - Street 2:
Mailing Address - City:JURUPA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91752-0172
Mailing Address - Country:US
Mailing Address - Phone:323-547-4545
Mailing Address - Fax:
Practice Address - Street 1:4145 LA SIERRA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-2938
Practice Address - Country:US
Practice Address - Phone:323-547-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-26
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC12852101YM0800X
CALMFT134932106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health