MEDICARE: LEAH GIBSON-SMITH LPC

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	101YP2500X	Professional Counselor	3160	LA
2	106H00000X	Marriage & Family Therapist	1037	LA

General Provider Information

NPI Number	:	1326427048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH GIBSON-SMITH LPC

Provider Business Mailing Address
First Line	:	1003 S SPRUCE ST
Second Line	:
City	:	VIVIAN
State	:	LA
Zip	:	71082-3200
Country	:	US
Telephone Number	:	318-375-3239
Fax Number	:	318-375-2755

Provider Business Practice Location Address
First Line	:	1003 S SPRUCE ST
Second Line	:
City	:	VIVIAN
State	:	LA
Zip	:	71082-3200
Country	:	US
Telephone Number	:	318-375-3239
Fax Number	:	318-375-2755

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

Provider Enumeration Date	:	05/27/2015
Last Update Date	:	05/27/2015

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Directions to “ LEAH GIBSON-SMITH LPC” Practice Location

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