Provider Demographics
NPI:1063999282
Name:SMITH, LEYLA (MFT)
Entity type:Individual
Prefix:
First Name:LEYLA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:LEYLA
Other - Middle Name:
Other - Last Name:JOLIVETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 491750
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-1750
Mailing Address - Country:US
Mailing Address - Phone:530-604-5069
Mailing Address - Fax:
Practice Address - Street 1:1170 INDUSTRIAL ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002
Practice Address - Country:US
Practice Address - Phone:530-722-9957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-20
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5309101Y00000X
CA107736101YM0800X
CA123861106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health