MEDICARE: MS. LEIGH ANN SMITH L.P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	102L00000X	Psychoanalyst	19230	TX

General Provider Information

NPI Number	:	1003119967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LEIGH ANN SMITH L.P.C.

Provider Business Mailing Address
First Line	:	1810 8TH AVE
Second Line	:	BOX 16
City	:	FORT WORTH
State	:	TX
Zip	:	76110-1352
Country	:	US
Telephone Number	:	817-926-1148
Fax Number	:

Provider Business Practice Location Address
First Line	:	1810 8TH AVE
Second Line	:	BOX 16
City	:	FORT WORTH
State	:	TX
Zip	:	76110-1352
Country	:	US
Telephone Number	:	817-926-1148
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2010
Last Update Date	:	12/15/2010

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