Provider Demographics
NPI:1346790359
Name:SMITH, LEAH
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 SILVER FOX TRL
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-8805
Mailing Address - Country:US
Mailing Address - Phone:567-203-3355
Mailing Address - Fax:567-212-3194
Practice Address - Street 1:1060 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-3715
Practice Address - Country:US
Practice Address - Phone:567-203-3355
Practice Address - Fax:567-212-3194
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1600004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health