Healthcare Provider Details

I. General information

NPI: 1871475723
Provider Name (Legal Business Name): MCKENNA LEIGH SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21321 E OCOTILLO RD
QUEEN CREEK AZ
85142-5996
US

IV. Provider business mailing address

31764 N ROYAL OAK WAY
SAN TAN VALLEY AZ
85143-6343
US

V. Phone/Fax

Practice location:
  • Phone: 602-759-0512
  • Fax:
Mailing address:
  • Phone: 224-856-7403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: